Vulvar Lichen Sclerosus and Urinary Symptoms
Yes, vulvar lichen sclerosus can cause urinary urgency and suprapubic pain, though these symptoms are less common than the classic presentation of pruritus and dyspareunia. The mechanism involves anatomical distortion from scarring, introital stenosis causing obstructive voiding difficulties, and painful micturition from fissuring in the genital area.
Direct Urinary Manifestations
Urinary symptoms are documented in women with vulvar lichen sclerosus, though the exact prevalence varies across studies. 1 The British Association of Dermatologists guidelines specifically note that urinary symptoms and urinary incontinence are reported by women with LS, though one study showed these may be less common than in the general population. 1
The urinary symptoms arise through several mechanisms:
- Dysuria (painful urination) results from fissuring in the genital area, particularly when urine contacts inflamed or eroded tissue 1
- Introital stenosis from scarring can cause difficulties with micturition by creating mechanical obstruction or altered urinary stream 1
- Severe introital narrowing may present with problems during urination, requiring surgical intervention in some cases 1
Suprapubic Pain and Voiding Dysfunction
Painful micturition is a recognized complication of severe vulvar lichen sclerosus with extensive scarring. 2 A recent case report describes a woman with extensive vulvar involvement resulting in introital stenosis and painful micturition, demonstrating that suprapubic discomfort can occur when anatomical distortion is significant. 2
The pain mechanism involves:
- Obstructive voiding from introital stenosis creating increased bladder pressure and suprapubic discomfort 2
- Chronic inflammation and scarring affecting the anterior vulva and potentially causing referred pain 3
- Urinary or fecal incontinence reported as symptoms in some patients with anogenital LS 3
Clinical Pitfalls and Diagnostic Considerations
The primary symptoms of vulvar lichen sclerosus are intense pruritus (often worse at night), dyspareunia, and visible porcelain-white plaques with ecchymosis—not urinary symptoms. 1, 4 When urinary urgency or suprapubic pain are the presenting complaints, consider:
- Rule out concurrent urinary tract infection, overactive bladder, or interstitial cystitis before attributing symptoms solely to lichen sclerosus
- Examine for severe introital stenosis or labial fusion that could mechanically obstruct voiding 1, 4
- Assess for fissuring in the periurethral area that would cause dysuria with urine contact 1
- Consider that asymptomatic lichen sclerosus exists, so visible disease may be incidental rather than causative of urinary symptoms 1
Management Approach for Urinary Symptoms
Ultra-potent topical corticosteroids (clobetasol propionate 0.05%) applied twice daily for 2-3 months represent first-line therapy, even when urinary symptoms are present. 4 This addresses the underlying inflammation and may prevent progression of scarring that contributes to voiding dysfunction.
For established anatomical complications:
- Surgical intervention using vaginal wall reconstruction may be required when introital stenosis causes significant voiding difficulty or painful micturition 1, 2
- Postoperative topical steroids with vaginal dilators must be used to prevent readhesion and Koebnerization 1
- Surgery should only be considered after adequate trial of medical therapy and when anatomical distortion is clearly causing functional impairment 4
Long-term follow-up is essential given the 4-6% risk of malignant transformation to squamous cell carcinoma, regardless of whether urinary symptoms are present. 4, 5