Myths and Suggestions
Myths about Skin Disease and the Vulva
Vulval disease is primarily gynaecology
Vulval problems do not come under any one specialty. Gynaecology plays a role, but the dominant specialty involved is dermatology (skin specialists). However pain management, neurology, sexual health, physiotherapy and psychologists may all be important in certain patients. Being a “vulvologist” involves some knowledge of all these areas although no one person can have complete expertise. This is what makes vulval disease truly a multi-disciplinary area. The best doctor to see about vulval disease is one who is interested in it and has experience no matter what their background.
Lichen sclerosus can be managed long term with once or twice a week treatment
If you have been diagnosed with lichen sclerosus you will probably find that once treatment is started you will feel better quickly. Don’t assume however, that you can stop your treatment and are cured. This condition needs maintenance with ongoing treatment. Although you may feel fine just using creams once a week, make sure that you have regular checkups as this may not be sufficient for you and your problem may be getting worse even without warning symptoms.
Lichen sclerosus does not require follow up
Lichen sclerosus does occasionally remit but this is not common. This myth has arisen because it can be symptom free for long periods of time. Despite this most patients who stop treatment will eventually have a recurrence of their symptoms, and by the time this happens, there will frequently be more irreversible damage. The reasons why follow-up is important are:
- To monitor for cancer
- To adjust treatment
- To check for side effects of treatment
- To make sure scarring is not interfering with your ability to have an active sex life
Psoriasis can be cured
Psoriasis is a chronic condition for which there is most certainly no cure. Psoriasis may unpredictably go into remission for long periods of time. However there is always the risk that it will reactivate, particularly at times of emotional stress. Even though cure is not possible, this disease can be controlled. It is very unusual to find a patient with vulval psoriasis who is unable to control her condition with regular treatment.
Topical corticosteroids(cortisone creams) are dangerous and will thin your skin
Topical corticosteroid phobia is at epidemic proportions, not only in Australia but worldwide. Unfortunately, the side effects that are usually linked to the use of systemic (taken by mouth) corticosteroids have been attributed to topical corticosteroids(used as creams). The words “Use sparingly” which are invariably placed on labels by pharmacists are frightening but are just there because it is standard practice and goes back many years to the days when people used to think that if a little was good a lot was even better. The internet has also sensationalised the dangers of these medications and the popular push for all things “natural” has demonised them as truly hazardous.
The fact is that topical corticosteroids have been in use for 60 years, we have extensive knowledge of them and if used correctly they are very safe. The notion that skin will be somehow “thinned” by topical corticosteroids is the most pervading fear. On the vulva “thin skin” would mean visible veins, stretch marks and fragility so that skin would tear during intercourse.This is really unusual if these treatments are used correctly (at the right strength for the right period of time). In general, in the genital area, the use of a weak topical corticosteroid such as 1% hydrocortisone is very safe, even long term. Stronger steroids may be used, however, when appropriate and this is particularly so in lichen sclerosus. In reality the main side effect from topical corticosteroid is redness associated with a burning sensation. This reverses quickly when a lower potency steroid is used.