Introduction
In this post, I share what the science says about lichen sclerosus and pregnancy. Specifically, I look at treatment during pregnancy, risks and benefits of treating during pregnancy, and delivery.
*This post is evidence-based; I draw on the medical literature to share what you need to know about pregnancy and lichen sclerosus. Importantly, what I share is my interpretation of the science and data.
A Note on the Science of Lichen Sclerosus and Pregnancy
We are all about transparency here at Lichen Sclerosus Support Network. What does that mean? That means we are always as honest as possible about the information and guidance we provide to our LS community.
Thus, in the spirit of transparency, I want to note that there is not much research on lichen sclerosus and pregnancy. Of the few studies available, many are case studies (which are less robust than randomized controlled trials (RCTs)). Further, the majority of the available studies involve small groups of participants. Therefore, we need a lot more research on LS and pregnancy moving forward.
Nonetheless, we will work with what we have for now.
Does Lichen Sclerosus Get Better or Worse in Pregnancy?
This is a great question and one that we get a lot. The studies on this question are mixed. It is about 50/50 in the medical literature.
For example, a study by Helm et al. showed that half the patients in their study reported worsening symptoms during pregnancy. However, a study by Gunthert et al. showed that lichen sclerosus goes into remission during pregnancy. Another study by Nguyen et al. showed that their LS remained stable when patients were compliant and followed their treatment plan. Finally, a study by Dalziel et al. analyzed questionnaires from 45 people with vulvar lichen sclerosus. Of those 45 patients, 8 of them were pregnant with lichen sclerosus. Five of them stated their LS remained the same during pregnancy, and three stated they felt improvement during pregnancy.
Anecdotally, it is also a mixed bag. Many individuals tell me their LS went into remission during pregnancy, and they felt amazing. I have also heard from folks who say they were very symptomatic during pregnancy.
So which is it?
It seems that LS and pregnancy are individualized, like lichen sclerosus itself. That means everyone’s experience is unique. That said, the Nguyen et al. paper suggests that outcomes improve when patients comply with their treatment plan. Let us talk about that.
Treatment for Lichen Sclerosus During Pregnancy
Treatment for lichen sclerosus during pregnancy is the same for folks with LS who are not pregnant: topical corticosteroids. Suppose you are new here and are not familiar with topical corticosteroids. In that case, I have a post here and here that provides a deep dive into steroids.
Most dermatologists and gynecologists specializing in LS and vulvovaginal conditions counsel their pregnant patients to continue using their steroids.
Nguyen et al. followed 33 patients through pregnancy and post-partum. All participants were told to use their steroids as indicated. The strength and amount of steroid were determined on a per-case basis, depending on the severity of the lichen sclerosus.
The authors found that those who were compliant with their steroids had minor complications, and their LS symptoms were well-managed.
Two Case Study Reports
A case study is where a clinician follows a patient for a particular time and documents the findings.
A study by Haefner et al. looked at two cases of lichen sclerosus and pregnancy. They followed two patients throughout their pregnancy. The first patient declined to use steroids during pregnancy. They experienced itch, which grew in severity and continued post-partum. Post-partum, the patient agreed to use steroids which resulted in relief from the symptoms.
The second patient was asymptomatic during pregnancy. This means that although they had LS during pregnancy, the patient experienced no symptoms.
Risk Versus Benefits of Using Steroids During Pregnancy
All medications have risks and benefits. In fact, opting not to treat also comes with risks and benefits. This is an unfortunate fact about being human; we always have to weigh risk versus benefit to determine if something is best for us.
Topical corticosteroids are no different. Let’s discuss some of the risks and benefits.
Risks of Topical Steroids for Lichen Sclerosus During Pregnancy
Haefner et al. note that with topical corticosteroids, the risks and benefits must be discussed with the patient. Topical corticosteroids are absorbed via the vulvar/perianal skin. Things that impact how much of the medication is absorbed include
- applying a large amount of medication,
- applying the medication over a large surface of the body, such as the legs and/or back, and
- applying a dressing such as gauze over the site.
Luckily, none of these apply to vulvar LS. We use a small amount of medication on a very small body area – the vulva makes up 1% of the body. Further, folks with LS are not directed to use any kind of medical dressing/barrier on top of the medication.
OK, but what about the medication’s risks for the baby’s development?
This is certainly a question many parents-to-be/potential parents worry about. Side effects like developing cataracts (an eye condition where the eye gets cloudy) or immunosuppression have been shown to occur in babies born to individuals using systemic steroids. However, these side effects have not yet been reported to individuals using topical corticosteroids. Remember, lichen sclerosus is not, for the most part, treated with oral (systemic steroids) but with topical, non-systemic steroids.
Unfortunately, there are many more studies looking at systemic steroids and birth compared to topical corticosteroids; this area of research needs more attention. We do not (when this is published) have good controlled trials looking at the development and health of a fetus/baby whose parent used topical corticosteroids for lichen sclerosus.
Benefits of Topical Steroids for Lichen Sclerosus During Pregnancy
According to Nguyen et al. and Haefner et al., topical corticosteroids are considered safe for pregnancy and outweigh the risks. Benefits include
- symptom management and reduction,
- reducing the chances of vulvar cancer,
- keeping the tissue healthy for birth, and
- controlling the progression of the LS.
Of course, risks versus benefits are about more than just science. Ultimately, it is up to you to do what you think is best for you and your body (more on this in my next post).
Are Steroids Safe for Pregnancy: An Expert Shares
One of the leading LS dermatologists and researchers, Dr. Gayle Fischer, was interviewed on the Vulva Diaries, a podcast hosted by Dr. Amanda Selk (MD, MSc, FRCSC, OB/GYN).
Lichen Sclerosus and Pregnancy – What about Giving Birth?
Let’s talk about the actual delivery of the baby. Many folks with vulvar lichen sclerosus worry about giving birth. And, it is no wonder, given our propensity to tear. Some think you cannot have a vaginal birth with LS, but that is untrue. While it may not be possible for all, the literature shows that most folks with LS give birth vaginally.
For example, in the Nguyen et al. study, 82% of the pregnant participants with LS had a vaginal birth with minimal complications. Two participants had instrumental deliveries, and one had a C-section due to severe LS and not being compliant with their treatment.
Both patients in the Haefner et al. case study had vaginal births with minimal complications.
Conclusion
In sum, while many folks think they cannot get pregnant with LS, this is far from the truth. You can get pregnant with LS, manage your symptoms, and have a vaginal delivery (if this is what you want). In this post, we reviewed treatment for lichen sclerosus and pregnant folks, the risks versus benefits of treating during pregnancy, and what to expect for delivery.
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Sources Cited & Consulted
Dalziel KL. Effect of lichen sclerosus on sexual function and parturition. J Reprod Med. 1995 May;40(5):351-4. PMID: 7608874.
Günthert AR, Faber M, Knappe G, Hellriegel S, Emons G. Early onset vulvar Lichen Sclerosus in premenopausal women and oral contraceptives. Eur J Obstet Gynecol Reprod Biol. 2008 Mar;137(1):56-60. doi: 10.1016/j.ejogrb.2007.10.005. Epub 2007 Dec 4. PMID: 18055095.
Haefner HK, Pearlman MD, Barclay ML, Selvaggi SM. Lichen sclerosus in pregnancy: presentation of two cases. J Low Genit Tract Dis. 1999 Oct;3(4):260-3. doi: 10.1046/j.1526-0976.1999.34008.x. PMID: 25950672.
Nguyen Y, Bradford J, Fischer G. Lichen sclerosus in pregnancy: A review of 33 cases. The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2018 Dec;58(6):686-689. DOI: 10.1111/ajo.12812. PMID: 29920642.
The Vulva Diaries, Hosted by Dr. Amanda Selk – Interview with Dr. Gayle Fischer
