Sex Talk

My sore vagina is putting me off sex. What's wrong with me?

Dr Tlaleng Mofokeng answers your sex questions

02 September 2018 - 00:00
Lichen planus, which decreases sexual pleasure, is a chronic disease that requires multidisciplinary management.
Lichen planus, which decreases sexual pleasure, is a chronic disease that requires multidisciplinary management.
Image: 123RF/Senjoy

Q. I am unable to enjoy sex as my genitals are constantly painful. What is wrong with me?

A. Lichen planus occurs when the immune system mistakenly attacks cells of the skin or mucous membranes. On skin lichen planus appears as purplish, itchy, flat-topped bumps. On mucous membranes, such as in the mouth, it forms lacy, white patches, sometimes with painful sores. Lichen planus usually goes away on its own.

Lichen planus affects multiple systems in the body. Due to its genital presentation, it is often missed and left untreated. Due to the nature of the disease, the symptoms causing most discomfort mean that the initial patient consultation may be varied across many specialties for example, a family doctor, dermatologists, rheumatologists and gynaecologist.

Lichen planus can present at any age and is more common in women.

DYSFUNCTION

Sexual dysfunction presents with a combination of vulval and vaginal components. There is usually vulval pain and discomfort, burning, itching, painful oral and penetrative sex, bleeding after sex. The chronic vaginal discharge, burning on urination or difficulty in urinating may lead to a diagnosis of recurrent urinary tract infection or vaginal candidiasis.

A magnified illustration of Lichen planus.
A magnified illustration of Lichen planus.
Image: 123RF/Blueringmedia

As the disease progresses, it may cause visible distortion of the external genitalia, hardening of the vaginal canal and sometimes more than 50% occlusion, resulting in loss of sexual function, decreased sexual pleasure and deterioration in quality of life.

CAN WORSEN QUICKLY

There are different types of lichen planus and sometimes a biopsy of the skin is required to make a definitive diagnosis. An area of redness and hardening may extend to the anal area. The disease is chronic and requires a multidisciplinary management. It can worsen quickly over a short period and good adherence to treatment is key.

Treatment options are a combination of oral anti-inflammatory medication and intravaginal treatments. Surgery may be needed to treat vaginal adhesions and restore some sexual function.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

Do you have a question about sex?

E-mail your questions to lifestyle@sundaytimes.co.za with SEX TALK as the subject. Anonymity is assured.


X