Lichen Sclerosus – What It Is and How Best to Treat It

Lichen sclerosus is a chronic inflammatory skin condition that most commonly affects the vulva and perineal area. It can cause itching, soreness, thinning of the skin, tearing, and over time, scarring that leads to tightening of the vaginal entrance. While the condition can feel overwhelming, early diagnosis and structured treatment significantly improve long-term outcomes.

This guide explains what lichen sclerosus is, how it is treated, and why targeted lichen sclerosus dilator therapy can play an important role in maintaining comfort and function.

What Is Lichen Sclerosus?

Lichen sclerosus is believed to have an autoimmune component and is most common in post-menopausal women, although it can occur at any age. It typically presents with:

• Persistent itching (often severe)
• White, shiny or fragile skin
• Burning or discomfort
• Splitting or fissuring of the skin
• Pain during intercourse
• Progressive narrowing of the vaginal opening

Without consistent treatment, chronic inflammation can lead to fibrosis (scar tissue formation) and architectural changes of the vulva. Preventing this progression is central to management.

First-Line Treatment for Lichen Sclerosus

The gold standard treatment for lichen sclerosus is a high-potency topical corticosteroid, most commonly clobetasol propionate. When used correctly under medical supervision, it reduces inflammation, controls itching, and helps prevent further scarring.

However, while steroids address inflammation, they do not always reverse tissue tightening that has already developed. For patients experiencing narrowing or discomfort with penetration, mechanical support strategies may be recommended alongside medical therapy.

Why Vaginal Tightening Occurs in Lichen Sclerosus

In lichen sclerosus, chronic inflammation stimulates collagen remodelling and fibrosis. Over time this can:

• Reduce elasticity at the vaginal entrance
• Cause pain with intercourse or examinations
• Lead to avoidance of penetration due to fear of tearing
• Result in progressive narrowing if left unmanaged

Maintaining tissue flexibility is therefore a key part of long-term management.

Is Standard Dilator Therapy Always Necessary?

Traditional vaginal dilator sets are typically designed for conditions such as vaginismus or dyspareunia, where muscle spasm or fear-avoidance patterns require gradual progression through multiple sizes.

In contrast, most lichen sclerosus patients do not require graduated dilator sets. The issue is not usually muscular guarding or psychological avoidance. Instead, it is skin fragility and localised tightening at the introitus (vaginal entrance).

For many women with lichen sclerosus, what is needed is:

• Gentle, consistent maintenance stretching
• A size that reflects typical functional needs
• A smooth, skin-friendly surface designed for fragile tissue
• A device specifically shaped for LS-related anatomical change

This is where a purpose-designed lichen sclerosus dilator differs from standard graduated systems.

What Is Lichen Sclerosus Dilator Therapy?

Lichen sclerosus dilator therapy involves the regular use of a medical-grade dilator to help maintain vaginal opening width and elasticity. The aim is not aggressive stretching, but preservation of function and prevention of further narrowing.

Sessions are typically short and controlled, for example:

• 5–10 minutes per session
• Several times per week
• Always with adequate lubrication
• Never pushed to the point of sharp pain

This type of therapy is usually introduced once inflammation is under control with topical treatment.

Vagiwell 5LS – Designed Specifically for Lichen Sclerosus

The Vagiwell 5LS is unique in that it has been designed specifically for women with lichen sclerosus. It is not a multi-size graduated set. Instead, it is a single, purpose-designed dilator created to meet the typical needs of LS patients.

Unlike traditional dilator systems aimed at vaginismus or post-radiotherapy rehabilitation, Vagiwell 5LS recognises that:

• Most LS patients do not need multiple incremental sizes
• The goal is maintenance and gentle tissue support, not progressive stretching
• Tissue sensitivity and fragility must be prioritised

Key features include:

• A size appropriate for maintaining functional vaginal calibre
• Smooth, medical-grade silicone suitable for delicate LS-affected skin
• A design developed with LS patients in mind
• A simple, non-intimidating approach compared with multi-piece sets

At present, it remains one of the only dilators specifically designed for lichen sclerosus rather than adapted from other pelvic health conditions.

When Should You Consider a Lichen Sclerosus Dilator?

You may wish to discuss lichen sclerosus dilator therapy with your clinician if you:

• Notice increasing tightness at the vaginal entrance
• Experience pain during penetration despite steroid treatment
• Have difficulty tolerating examinations
• Have been advised to maintain vaginal calibre following scarring

Dilator use should always complement, not replace, prescribed medical treatment.

Final Thoughts

Lichen sclerosus is a long-term condition that requires consistent management. High-potency topical steroids remain the foundation of treatment, but maintaining tissue flexibility is equally important in preventing functional decline.

For many women, a purpose-built solution such as Vagiwell 5LS offers a practical and clinically appropriate way to support comfort and vaginal health. Unlike standard graduated dilator sets, it is specifically designed for the needs of lichen sclerosus patients.

If you are concerned about narrowing or discomfort, speak to your GP, gynaecologist, or pelvic health specialist about whether lichen sclerosus dilator therapy is right for you.