The impact of chronic vulvar dystrophy on sexual function at menopause

Abstract

Chronic vulvar dystrophy is defined as growth of abnormal skin on the vulva, having two types according to the thickness of the skin – thin as lichen sclerosus, or thick like squamous hyperplasia. Lichen sclerosus appears as white, shiny patches of parchment-like tegument on the labia affecting mainly menopausal women. Symptoms are variable, from no obvious manifestations to intense itching and increasing vulvar pain. The affected skin area can easily bleed sometimes just by touch, often making sexual intercourse impossible. With squamous hyperplasia the vulvar skin becomes thick with white elevations, causing intense itching. Treatment includes topical corticosteroid and testosterone application, retinoids to reduce the connective tissue destruction and in advanced cases surgery. We examined a number of 25 menopausal patients, aged between 48 and 64 diagnosed with vulvar dystrophy in the interval 2014–2016. A percentage of 92% experienced difficulties in engaging sexual intercourse due to local pain, itching, dryness sensation, bleeding or labial fusion. From these, a number of 14 patients (56%) declared that vulvar symptoms determined them to cease any sexual activity because of intense complaints (40%) or physical impossibility caused by labial fusion (16%). All patients declared that the vulvar dystrophy had a negative impact on their sexual function and couple activity, affecting their quality of life between 7 and 10 on a visual analog scale. Topical corticosteroid and testosterone application was useful in most cases, relieving the symptoms after 3 months in 72% of the cases, while in the rest of the cases where the disease caused scarring or fusion of the labia surgical treatment was necessary. In conclusion, based on our study group we can affirm that chronic vulvar dystrophy can be a debilitating disease, affecting greatly menopausal women's quality of sexual life with long-term psychological implications.