Today we talk about one of my favorite and least talked about topics – vaginal health. Sure, we all get that yearly (or every 3 years if you are in Canada) PAP, and address the odd infection as it arises, but what we don’t talk about is what’s normal, and what’s not. Just like any other muscle or organ system in the body – the pelvis and the area’s south of your waist need love and attention. I’m going to be writing a series of blogs devoted to vaginal health over the next few months to spread the word that having a vagina comes with a unique set of responsibilities, but has endless potential to enhance your life.
Just like you know the skin on the the external surfaces of most of your body, it’s important to know the skin in your pelvic region as well. There are dermatological conditions of the vagina that can cause a lot of pain and even lead to vulvar cancer. Common dermatological afflictions of the vagina include infectious vaginitis (due to an unhealthy flora), lichen planus (an inflammatory skin condition that affects the vulva, the vagina and the mouth), lichen simplex chronicus (chronic irritation to the vaginal tissues causing inflammatory scarring) and what we are talking about today – Lichen Sclerosus (LS).
LS is an inflammatory dermatosis that arises due to an autoimmune (self-attack) process in the body and is more common after menopause. I want to raise awareness for this condition because it is often underdiagnosed and missed, thus lengthening the period to proper diagnosis and therefore treatment – throughout all medical communities.
Vaginal tissues are easily irritated by laundry detergents, soaps, lotions and urine as well as intimate interactions due to the nature of mucosa lining the vagina. LS can often be misdiagnosed as bacterial vaginosis or vaginal candida infections in it’s early stages due to common discomfort and itching. Often when a woman walks into the doctor’s office or walk-in clinic – practitioners don’t even so much as take a look at the tissues before treating them – mainly due to the inconvenience of the area, time restrictions and timidity of the patient. It’s easier to call it a yeast infection and move on with the day.
In the early phases of LS, the clinical presentation may not look like lichen sclerosis at all! At first it can be itchy, there may be pain with intercourse, unusual swelling with pain, pain with urination or bleeding of the genitals in raw spots where the tissues have thinned and become delicate. Eventually in the later stages of LS, scarring to the vaginal tissues occurs with loss of the labia minora (inner labia) and burying of the clitoris if the clitoral hood fuses together over top of it.
These processes can cause pain and reduced tissue elasticity as well as make orgasm more difficult to achieve. LS has a significant impact on the affected patient on all plains – physically, emotionally and psychologically thus drastically affecting self confidence, intimate relationships and quality of life.
First line treatment is application of steroid cream to the tissues on a regular basis. If this fails, creams that modulate the immune system locally are applied. Both of these come with their own benefits as well as challenges and risks including but not limited to further thinning of vaginal tissues and low patient compliance. Estrogen support for the tissues and manual manipulation are also often used to prevent scarring and thinning. As women age and become post-menopausal, corticosteroid creams present even more risks for tissue thinning and discomfort. Currently there is no cure for LS nor is there a comprehensive treatment that suits all patients equally.
In managing LS, the goal is to be able to reduce applications of topical preparations and use lower doses and potencies of steroids creams, yet still be able to maintain comfort, prevent progression and increase the ease and pleasure of intimate relationships.
There is hope for this if we can mediate inflammation in the body, specifically the pelvic area, and simultaneously stimulate healthy tissue remodeling and break down of fibrous scar tissue. Platelet-Rich Plasma (PRP), derived from our own blood and an easy in office procedure has shown promising results in the field of gynecology and dermatology (aka vulvar dermatology). Platelets, derived from our own blood release growth factors important for inflammation reduction, stimulation of new blood supply, collagen synthesis and dissolution of fibrous scar tissue.
Naturopathic Medicine uses a large toolbox of different modalities to help combat difficult and often irretractible conditions using integrative approaches. We can truly combine all avenues of expertise to offer patients the best care. In November 2016, Behnia-Willison, Pour et al published a study on the use of platelet-rich plasma for vulvovaginal autoimmune conditions like lichen sclerosus. Results showed that PRP may be a safe and valuable alternative to surgery and steroid therapies – which both post their own set of risks.
Hopefully in the future we will have more studies with larger sample sizes and randomized controlled trials to further support the use of PRP, making it more widely available to patients in need. Nature gave us these inherent healing mechanisms. Let’s make sure we put them to good use. At INMC, we do!