Sexual dysfunction is often multifactorial, and while pelvic floor muscle impairments are a common contributor, dermatological conditions can also play a significant role. Two important but sometimes overlooked conditions, lichen sclerosus (LS) and lichen planus (LP), can dramatically affect sexual health, patient comfort, and overall quality of life.

For pelvic health providers, recognizing the symptoms and understanding when to refer is essential to providing comprehensive care.

What are Lichen Sclerosus and Lichen Planus?

• Lichen sclerosus (LS): A chronic, inflammatory skin condition that often affects the vulva or penis. LS can cause itching, burning, white patches of thin skin, and, over time, scarring may restrict function and contribute to painful intercourse.
• Lichen planus (LP): Another inflammatory condition that may affect skin, mucous membranes, and genital tissue. LP can cause redness, erosion, and pain that interfere with both daily activities and sexual function.

Both conditions are underdiagnosed, frequently misunderstood by patients and doctors, and often mistaken for recurrent infections or generalized pelvic pain.

Key Research Highlights

• High Prevalence of Sexual Dysfunction in LS
  • A systematic review and meta-analysis reported that nearly 60% of women with vulvar lichen sclerosus experience sexual dysfunction, with dyspareunia (pain during intercourse) being the most common issue (1).
• Impact on Quality of Life and Physical Activity
  • A cross-sectional study of 603 women with LS or LP found significant decreases in quality of life, overall health status, and physical activity, highlighting how genital dermatologic conditions can profoundly affect daily functioning and mobility (2).
• Sexual Distress in Genital Erosive Lichen Planus (GELP)
  • Research involving women with erosive genital LP showed high levels of sexual distress and reduced quality of life, with many participants scoring above thresholds that indicate serious impact on sexual well-being (3).
• Psychosexual Counseling Improves Outcomes
  • A randomized controlled trial found that combining psychosexual counseling with usual medical care led to significant improvements in sexual function and overall quality of life for women with LS, particularly in domains directly related to sexual well-being (4).
• Pelvic Floor Physical Therapy as a Supportive Strategy
  • According to a summary from a Pelvic Health PT blog, pelvic floor physical therapy, including techniques like myofascial release, soft tissue mobilization, clitoral hood mobilization, and breathwork, can alleviate dyspareunia and improve tissue mobility in individuals with LS (5).

The Pelvic Rehab Provider’s Role
Unrecognized dermatological conditions can prolong suffering, worsen pelvic pain, and contribute to psychological distress around sexual health. As part of a multidisciplinary team, pelvic rehab providers are instrumental in improving outcomes for patients with these complex conditions.

While pelvic health professionals do not diagnose dermatological conditions, they are often the first, or sometimes the only, clinicians who take the time to observe and inspect the vulva as part of a comprehensive evaluation. This makes the Q-tip test a critical component of the pelvic health exam. Through careful observation, we can identify tissue changes, localized pain responses, or dermatological conditions that may otherwise go unnoticed. Incorporating this exam allows us not only to guide treatment appropriately within the scope of pelvic rehabilitation but also to recognize when referral to gynecology, dermatology, or another specialist is necessary. This ensures patients receive timely and comprehensive care for conditions that directly impact pelvic health and quality of life. Common clinical presentations include:

• Patients report persistent pain, itching, burning in the vulva, and tearing (especially at the posterior fourchette) during sexual activity.

• Observation of skin changes in the perineal or vulvar region during external pelvic exams. This can present as waxy, shiny, thin, and similar appearance to vitiligo.
• Patients with pelvic pain who have not responded to traditional pelvic rehab approaches.

By identifying potential signs of LS or LP, PTs can facilitate timely referral to dermatology or gynecology/urology, ensuring patients receive the medical care they need. Once managed medically, pelvic rehabilitation can then help restore comfort, optimize pelvic floor function, and improve confidence in sexual activity.

Want to expand your skills in treating sexual dysfunction related to pelvic floor health?
Join us for Sexual Medicine in Pelvic Rehab, a remote course on September 27–28, 2025, where Tara Sullivan, PT, DPT, PRPC, WCS, IF will dive deep into evidence-based strategies for addressing sexual dysfunction, including conditions like lichen sclerosus and lichen planus.

Register today to enhance your clinical expertise and confidence in this essential area of practice.

References

1. Pope R, Lee MH, Myers A, Song J, Abou Ghayda R, Kim JY, Hong SH, Lee SB, Koyanagi A, Jacob L, Smith L, Shin JI. Lichen Sclerosus and Sexual Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2022 Nov;19(11):1616-1624. doi: 10.1016/j.jsxm.2022.07.011. Epub 2022 Sep 15. PMID: 36115787.
2. Dietz RJ, van de Berg NJ, van der Vegt AJ, van den Berg CB, van der Marel IC, van Wijk FH, Maliepaard M, van Beekhuizen HJ, van Doorn HC. Impact of vulvar lichen sclerosus and lichen planus on quality of life, mobility, bicycling, physical activity, and health. Maturitas. 2025 Aug;199:108651. doi: 10.1016/j.maturitas.2025.108651. Epub 2025 Jun 26. PMID: 40592218.
3. Skullerud, Kristin Helene MD1; Gjersvik, Petter MD, PhD2; Eberhard-Gran, Malin MD, PhD1; Pripp, Are Hugo PhD3; Qvigstad, Erik MD, PhD2; Vangen, Siri MD, PhD1; Helgesen, Anne Lise Ording MD, PhD4. Sexual Distress and Quality of Life in Women With Genital Erosive Lichen Planus—A Cross-sectional Study. Journal of Lower Genital Tract Disease 29(1):p 72-75, January 2025. | DOI: 10.1097/LGT.0000000000000847
4. Vittrup G, Westmark S, Riis J, Mørup L, Heilesen T, Jensen D, Melgaard D. The Impact of Psychosexual Counseling in Women With Lichen Sclerosus: A Randomized Controlled Trial. J Low Genit Tract Dis. 2022 Jul 1;26(3):258-264. doi: 10.1097/LGT.0000000000000669. Epub 2022 Mar 25. PMID: 35333024; PMCID: PMC9232275.
5. Dy, Debbie (2025, August 29). Lichen Sclerosus & Pelvic Floor Physical Therapy: How to Manage Symptoms & Improve Vulvar Health. Femina Physical Therapy. https://feminapt.com/blog/lichen-sclerosus-pelvic-floor-physical-therapy-how-to-manage-symptoms-improve-vulvar-health