arrow-small-left Created with Sketch. arrow-small-right Created with Sketch. Carat Left arrow Created with Sketch. check Created with Sketch. circle carat down circle-down Created with Sketch. circle-up Created with Sketch. clock Created with Sketch. difficulty Created with Sketch. download Created with Sketch. email email Created with Sketch. facebook logo-facebook Created with Sketch. logo-instagram Created with Sketch. logo-linkedin Created with Sketch. linkround Created with Sketch. minus plus preptime Created with Sketch. print Created with Sketch. Created with Sketch. logo-soundcloud Created with Sketch. twitter logo-twitter Created with Sketch. logo-youtube Created with Sketch.

Ask an Expert: Q&A – September 2021

For health professionals 27 Sep 2021
doctor consulting with a patient

'Ask an Expert: Q&A' is a place for health professionals to ask our team of experts about cases seen in work and/or clinical practice.

Questions can cover a wide range of women’s health topics and will be answered by an expert in the multidisciplinary Jean Hailes health professional team. Read more about this series or learn how to ask a question here.

If you are not a health professional but have your own health question, visit our 'Ask Dr Jean' pages.

Answering your questions for this edition of 'Ask an Expert: Q&A' is Tanja Bohl, Jean Hailes dermatologist.

Question

A 75 year-old woman has had vulval pain for months with dyspareunia. Her main concern is loss of pleasure during sex. She is using Ovestin and KY lubricant without any improvement. She was previously using a corticosteriod cream. Examination reveals a white shiny vulva. I have referred her for a biopsy to rule out lichen sclerosis. What else can I do?

Answer

From Jean Hailes dermatologist Dr Tanja Bohl

I think what you have done is good. Please consider the following:

  • If you haven’t done so already take a swab for candida (low vaginal). I realise it’s not something you would normally associate with a 75 year-old postmenopausal woman, but I have been surprised with positive results before.
  • If the vulva is white all over I assume you are thinking lichen sclerosis or possibly hypertrophic lichen planus. It is good to avoid steroids until the biopsy is completed as it may interfere with the results.

The following things are for comfort and avoiding aggravating the vulva rather than specific treatment.

  • QV Intensive Body Moisturiser can be used as required, it won’t interfere with biopsy results. Often the vestibule is considered ‘inside’, so it’s important she parts the labia minora and gently cleanses and applies the ointment here. Dermeeze ointment is more runny but also good.
  • I would ask her to ‘walk me through’ how she cleans her vulva in the bath or shower and after going to the toilet. Again I find this of value – some women will say things like a non-scented, no-soap cleanser and when I run through it they apply it neat! I advise the use of salt water – tiny sprinkle of salt in a nozzle topped bottle – so she can sit on the toilet and squeeze it to cleanse and soothe. If it stings, there is too much salt. There are many variations on this theme, the main thing is to make it doable.
  • Cold compresses are useful but if she needs this for relief you should probably make a phone call to prioritise her appointment.
  • An antihistamine that sedates – Phenergan 10mg (occasionally 25mg) overnight is sometimes worth trying but again if she is very uncomfortable a referral should be a priority.

Do you have a women's health clinical question for one of our experts?

Go to 'Ask an Expert'

All rea­son­able steps have been tak­en to ensure the infor­ma­tion cre­at­ed by Jean Hailes Foun­da­tion, and pub­lished on this web­site is accu­rate as at the time of its creation. 

Last updated: 
17 January 2024
 | 
Last reviewed: 
10 November 2024