Itchy Privates
By Rajal Patel, MD
Interview by Stephanie Bouchard
Fact checked by Jim Lacy
Q: My skin is scaly and itchy in my private areas. What’s going on?
A: First things first: If you see something on your vulva, anus, or penis and you don’t know what it is and it’s freaking you out, go see your gynecologist or primary care provider. There are so many different lesions that can be on the vulva and genitals; not all of them are STDs [sexually transmitted diseases].
Q: I searched images online, and they say it’s lichen? Like on trees? Is this an STI [sexually transmitted infection]?
A: Lichen sclerosus may sometimes look a little like lichen on trees: white-ish, maybe some gray depending on the color of the skin, and sometimes raised and crinkly looking. But it’s not the same thing, and you can’t get it from coming in contact with lichen when you’re outdoors.
Lichen sclerosus is an autoimmune skin condition, not a sexually transmitted infection. It is not contagious. The exact cause of lichen sclerosus is not known. It occurs most often in low-estrogen states so, while men can develop it, it’s more likely to occur in postmenopausal or postpartum women and in children. In men, it’s more typical if they’re not circumcised.
It also tends to run in families, and while it can appear elsewhere on the body, it’s most commonly found in the genital area and around the anus. Itching and scaly and cracked skin are the most common symptoms.
Q: Are there any other symptoms of lichen sclerosus?
A: People with lichen sclerosus can experience pain with urination, defecation, and intercourse; burning and splitting skin; and constipation (although constipation is more common in children than in adults).
In extreme cases in women, the outer folds of skin bordering the vulva — particularly the innermost folds, called the labia minora — can fuse, making urination and orgasm difficult or impossible. In uncircumcised men, the foreskin of the penis can fuse to the glans. There’s also a higher risk of developing squamous cell carcinoma, and for women, a precancerous condition called differentiated vulvar intraepithelial neoplasia (dVIN).
Q: How is it treated?
A: For most people, lichen sclerosus is well managed with topical steroids. A cure doesn’t exist right now for this condition, so the goal is to manage it to reduce or eliminate symptoms. There is some discussion about eating an autoimmune diet to help with inflammatory response symptoms, but I haven’t seen any data or studies that support diet as part of treatment for lichen sclerosus.
Because this is a lifelong condition that can vary throughout its course, it’s important to work with a professional — a gynecologist, dermatologist, urologist, or pediatrician — who has experience with it.
Rajal Patel, MD, is a gynecologist with a special interest in vulvar health at Northwestern Medicine’s Comprehensive Program for Vulvar and Vaginal Health.
Originally published in the Spring/Summer 2025 print issue.
Stephanie Bouchard is a freelance journalist who writes about health and wellness, lifestyles, and pets.
