In a typical case, small pearly white spots develop on the genital skin (vulva). The spots are usually itchy. However, in some people, there is no itch or other discomfort and lichen sclerosus is sometimes diagnosed by chance when the genitals are examined by a doctor for another reason. In about 3 in 10 cases, the skin around the back passage (anus) is also affected. Sometimes only the skin around the anus is affected. Typically, the itch and irritation becomes persistent and distressing. The itch tends to be worse at night which can disturb sleep. Sometimes soreness rather than itch is the main symptom. Lichen sclerosus is a skin condition only and does not extend into the vagina or inside the anus.
Over time, the white spots may become larger and join together. The whole vulva and/or anal skin may then become white and be more fragile than normal. The fragile skin may become damaged, inflamed, raw, and prone to painful splitting and cracking. It may become painful to have sex. If the anal skin is affected, passing poo (faeces) may cause pain.
If left untreated, over months or years the vulva may shrink (atrophy). In some cases the changes of the vulval skin may make the entrance to the vagina narrower. This can make it difficult or painful to have sex. Also, thrush and other infections tend to be more common if the vulva is sore or cracked.
Symptoms may slowly get worse but not all the above symptoms may occur. It can take months or years from the first small spots to progress to more severe symptoms. At first the symptoms may be mistaken for thrush or other problems