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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 yrs experience, awarding winning educator
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I was diagnosed with Lichen Sclerosis in Nov 2014. Leading

Resolved Question:

I was diagnosed with Lichen Sclerosis in Nov 2014. Leading up to my diagnosis I had had many Drs app., and have suffered a lot of narrowing, deterioration and scarring to the point where intercourse is impossible. The dermovate has given me comfort e, g I can walk without feeling I am going ti split in two. I am 51yrs and thd LS NHS and Macmillan websites have given me advice on the products to ask my Dr. For which has been invaluable. I have yet to meet a GP at my Health Centre or Pharmacist within my small town who can advise re Lichen Sclerosis. Before this, a smear was a routine which was just one of those appointments I just got in with. I have had one sexual partner (my husband of 30yrs) and one pregnancy so boring on the spectrum of sexual health. My recent attempt of a smear filled me with dread. The GP was not LS aware and was ignorant of the difficulties I explained and I had to really stress how I didn't see how a smear was possible. I struggle to insert the thin applicator that comes with the product, 'replens'. After an uncomfortable attempt of which I had to bring to a halt the GP suggested a smear when I eventually see a gynaecologist under general Anaesthetic? I have yet to meet a Practitioner who shows any real knowledge and don't trust this is something to agree to. Surely nothing that doesn't fit awake is goingnto fit just because Im under anaesthetic?

Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. C. replied 2 years ago.
Hi, It's Dr. C. Board certified Ob-gyne with 30+ years of experience. I can help you today. For such situation, I have a woman prep with vaginal estrogen for 2 weeks prior to her exam. Then upon entry into the exam room, she is given 3 cotton balls soaked in local anesthetic. These are placed just inside the opening of the vagina for 10 minutes. When I enter the room in 10 minutes, the balls are left in place while I take the history and we chat. When ready to examine, I remove the cotton balls with a thin forcep. It makes a world of difference regarding patient comfort. I hope this was helpful.
Customer: replied 2 years ago.

Your answer covers thd pain side of thd smear, however I am looking for assurance of no further tearing during procedure as the narrowing is now so


Expert:  Dr. C. replied 2 years ago.
Yes I would use a pediatric speculum in such a situation. For longer term management, I would refer a patient for dilator therapy with a physical therapist who specializes in guiding women with such scarring and narrowed introituses. As a last resort, vaginal reconstruction can be an option is a woman wants to restore sexual capacity. Anything else?
Customer: replied 2 years ago.

Will Lichen Sclerosis eventually destroy any reconstruction?

Expert:  Dr. C. replied 2 years ago.
Not necessarily if it's kept healthy. Usually we'd use a combination of topical estrogen cream along with Clobetasol. That's my preferred steroid but the Dermovate & Trimovate serve that same purpose. Then regular dilator treatment (or regular sex) to upkeep. Anything else?
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