Lichen sclerosus and pelvic floor therapy

“I see a lot of women with this condition who have simply resolved to no longer have sex. And I ask each one the same thing.” The pelvic floor therapist sat on the chair across from me. “Wouldn’t you at least like to have the choice to have sex again?”

“Of course,” I responded. This conversation made me feel as though there was more than just hope for recovery; there was an actual course of treatment.

Photo by Ann H on

So, why see a pelvic floor therapist for lichen sclerosus?

My PF therapist is my new best friend. One of the LS issues is that it can cause architectural changes to the vulva. One of the menopause issues is that it can cause architectural changes to the vulva. So, really, a PF therapist is someone you want on your team regardless.

According to my PF therapist, topical ointments, oils and creams need to reach the deeper layers of tissue since that’s where the inflammation occurs in LS. Massaging any lotions for at least 90 seconds assists in the delivery of the oil or ointment to those tissues.

She gave me samples of creams and taught me how to massage the vulvar tissues to improve their elasticity. She recommended that I use CeraVe® because it contains ceramides.

What are ceramides? According to a November 2021 article in Today

In short, ceramides are lipids (fatty molecules) that are found in the topmost layer of the skin to function as a barrier to protect the skin and help lock in moisture.1

On October 25, 2020, Healthline had this to say:

Ceramides are made up of long-chain fatty acids that link with other important molecules to promote cellular function. Ceramides help create a barrier to prevent permeability. This locks moisture into your skin, which helps prevent dryness and irritation.2

My years of working with plant oils told me that jojoba oil would be the most natural option since it is considered the closest to skin’s composition and is reported to be high in ceramides. More expensive but more natural than Cerave® and I don’t need a lot of it at a time. I did appreciate the free samples and added them to my supply of salves and lotions under the bathroom sink. If nothing else worked, I’d circle back to the samples. 

Along with lotions and massage techniques, my PF therapist checked my pelvic floor muscles. One side had atrophied and she sent a recommendation along to my GP for another specialist to work with me (since I’ve had a previous spinal injury that could be involved), as well, she gave me specific pelvic floor exercises to see if I could improve the muscle tone on that side.

Can pelvic floor dysfunction cause vulvar pain?

If you have chronically tight pelvic floor muscles, it can affect the nerves. Irritated nerves can feel like vulvar or vaginal itching. If you have a hormone imbalance causing tissue atrophy, the tissue is less lubricated and more prone to irritation. Dry, irritated tissue can also feel like vulvar or vaginal itching. 3

Often, women with LS report sensations like burning, throbbing, itching and even skin crawling. A good pelvic floor therapist can help to alleviate some of these complaints.

Not all health care policies cover pelvic floor therapy, so you’ll have to look into it. I see my PF therapist about every 5 or 6 weeks for a total of 4 appointments. She teaches me practices I can do on my own that put my health back into my own hands. Literally. 😉

By the next appointment, after practicing the exercises she gave me, I had already improved my muscle tone and greatly improved the elasticity and quality of my vulva tissues.

I’m 3 appointments in and, honestly, my vulva/vagina has never looked so good! It looks better than it did when I was a virgin. I’m calling it my virgina now.

Look for a pelvic floor therapist to support you in restoring your vulva and pelvic floor health. You can also find videos and information online, though it’s nice to have someone responding to your specific needs in person.

This post is part of a 30-day series raising awareness of LS. Join my mailing list below to be notified when my book on lichen sclerosus is published and available for sale.

Much love,


Read the next post in the series: Vaginal atrophy or lichen sclerosus?

Lichen Sclerosus: Body, Mind & Spirit Practices to Heal the Stress of LS

Pick up your copy of the most recently published book on LS. Everything covered in this blog series and more! 

**This blog is meant to inform, not diagnose or treat specific health conditions. It is not a substitute for professional medical advice, diagnosis and treatment. Always consult your doctor or health care practitioner.




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