Squamous cell hyperplasia and lichen planus
Squamous cell hyperplasia of the vulva
Squamous cell hyperplasia (SCH) is an abnormal growth of the skin of the vulva. It usually occurs before the menopause. The vulva may be pink or red, or it may have raised white patches. SCH usually affects the hood of the clitoris, the outer lips (labia majora), the groove between the outer and inner lips (labia minora) and the back of the entrance to the vagina. The affected skin may also extend to the thighs. Scratching causes thick, hardened patches on the vulval to appear. A biopsy (under local anaesthetic) is often performed to diagnose the problem as many things can trigger itching of the vulva. The itching generally stops with the correct treatment. The usual treatment is with powerful steroid creams. These should be used sparingly twice a day for several weeks. Your doctor will explain the treatment regime to you. Don’t expect it to improve overnight. It may require long-term treatment of these creams or ointments.
Squamous cell hyperplasia is sometimes seen next to areas of cancer, although the risk of cancer developing if you have SCH is small. Self-examination is important. You should alert your doctor if there is any worsening of your condition, if any lumps occur or if there is any bleeding from the vulva.
Lichen planus is another skin condition. It may affect the mouth and external genitalia too. It often involves the vagina as well as the vulva. It can resemble other vulval skin conditions. It is diagnosed by biopsy, which is often performed under local anaesthetic. A small area of skin is removed and sent for analysis.
We don’t know what causes lichen planus. It is not an infectious disease. The thin mucous membrane inside the mouth and vagina lose their top layer when they become involved with lichen planus, so red erosions may develop here. Erosive lichen planus may be painful in the mouth and vagina and secondary infection may occur resulting in a narrowing of the vagina.
Lichen planus is often improved with steroid creams and ointments. Occasionally we may have to use tablets steroids or other tablets that dampen down the body’s immune response. Some of these tablet treatments need careful monitoring with blood tests.
You should pay close attention to any changes in the vaginal discharge. If vaginal discharge occurs, it may indicate an erosion or secondary infection. Medication is usually given continuously. Regular visits with your doctor will be necessary. Self-examination is important in lichen planus, as there is a very small association with the development of vulval cancer. You should alert your doctor if there is any worsening of your condition, if any lumps occur or if there is any bleeding from the vulva.
Support groups and other resources
The vulval pain society (VPS) provides women with information on vulvodynia and other vulval disorders
Vulval Pain Society
PO box 514
The vulval pain society
National lichen sclerosus support group
Interstitial cystitis support group of the UK
National vulvodynia association
Vulvar pain foundation:
Interstitial Cystitis Association
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