Lichen Sclerosus and painful sex: how physio helps

Lichen sclerosus can be a scary diagnosis. Sex has been painful for a while, but then you get this diagnosis and start Dr Googling. That then brings on a panic when you read all the stories of women who seem to still be struggling. What can you do? The good news is that pelvic physiotherapy can be a huge help.

Wait, physio for painful sex? That sounds weird.

If that sounds weird to you, let me explain. A big part of painful sex is overactive pelvic floor muscles. Like any other muscles in your body, they can be physically “tight” or shortened; when this happens, stretching them hurts. And the pelvic floor muscles are stretched any time anything goes into the vagina. Muscles can also be overactive (they react too much) or oversensitive (they feel too much). Pelvic physio is brilliant to change both problems.

OK, treating muscles for pain with sex makes sense – but what about the skin in lichen sclerosus?

In lichen sclerosus, there are changes to the tissue of the vulva, including the clitoris, labia (lips) and the introitus (the opening itself). Inflammation leads to changes in the tissue, such as hyperkeratosis (a thickening of the skin) and scarring. These tissue changes can lead to restriction of tissue movement. Well, physio is all about restoring normal movement – and the movement of the skin is no exception! Manual therapy helps restore normal movement of the tissue of the vulva and vaginal opening. Gentle, progressive manual therapy can lead to wonderful changes to your symptoms. It doesn’t have to be super uncomfortable. A slight discomfort may occur, but a pelvic physio experienced in this area will be guided by your level of tolerance.

Think of it like a scar.

When a scar forms, the tissue around it becomes tight. This can make it uncomfortable when it is rubbed or moved wrong. But everyone knows the feeling of “good discomfort”. This is where something is uncomfortable, but your nervous system and brain can feel that it is actually helpful. It’s a therapeutic discomfort! A low-level discomfort can therefore be a welcome feeling, especially when it eases as it goes along. This is what happens when doing gentle manual therapy for restricted tissue in lichen sclerosus.

Sounds scary – isn’t the tissue fragile?

One symptom of lichen sclerosus can be fissuring or tearing with sex (or anything going into the vagina). This usually happens at the lower part of the opening. Sometimes, but not always, there is a small amount of bleeding, too. This sounds like something that shouldn’t be pushed around, for sure! It’s all a question of degree. When the tissue is resilient enough to take a tiny bit of pressure (which it usually is), this therapeutic pressure can be gradually built up over time.

This sounds like what I need – how do I get help?

The first thing you need to find is a pelvic physio. You then need to ask your pelvic physio if they have experience in doing manual therapy of the vulva and vagina. Pelvic physios are a wonderful breed, but they don’t all work the same way. So it’s important you find out whether this is something they do. Then make your first appointment. You won’t regret it!