Lichen Sclerosus and Sex: Can You Have Sex, and How Can Treatment Help?

Written and reviewed by Dr Shirin Lakhani MBBS MRCGP DRCOG — GMC No. 4634863 | CQC-Registered Practitioner | Medical Director, Elite Aesthetics, Near London | UK Trainer for the O-Shot

One of the most distressing aspects of lichen sclerosus — and one that is least often spoken about openly — is its profound impact on a woman’s sex life. Studies show that up to 75% of women with vulvar lichen sclerosus experience painful sex (dyspareunia), and nearly half report that penetrative intercourse has become impossible altogether. Yet far too many women are told simply to “manage” their symptoms with steroid creams and learn to live with the consequences for their intimacy and relationships.

At Elite Aesthetics in Near London — Dr Shirin Lakhani works with women with lichen sclerosus every week. She is one of the UK’s most experienced practitioners in PRP-based treatments for LS, and a UK Trainer for the O-Shot. In this guide, she explains why lichen sclerosus makes sex painful, what is actually happening to the tissue, and what modern treatment options — including the O-Shot and Morpheus8V — can do to restore comfortable, confident intimacy.

How Does Lichen Sclerosus Affect Sex?

Lichen sclerosus is a chronic inflammatory skin condition that primarily affects the vulva, causing the skin to become thin, white, and fragile. Over time, if the condition is not well controlled, it causes scarring and structural changes to the vulval architecture that have a direct and significant impact on sexual function.

• Dyspareunia (painful intercourse): The affected skin loses its elasticity and becomes stiff and fragile. Rather than stretching to accommodate penetration, it cracks, tears, and causes sharp, burning pain during or after sex.
• Fissuring: The vulval skin develops small tears or fissures at the vaginal opening that bleed during intercourse and take days or weeks to heal, only to recur with the next attempt.
• Narrowing (stenosis): Scarring over months and years can cause the vaginal opening to narrow, sometimes to the point where penetration becomes physically impossible.
• Loss of clitoral anatomy: Scar tissue can cause the clitoral hood to fuse, burying the clitoris and significantly reducing sexual sensation and the ability to reach orgasm.
• Reduced lubrication: Chronic inflammation affects the local tissues and can reduce natural lubrication, increasing friction and pain during sex.
• Psychological impact: Pain, altered anatomy, and a changed relationship with one’s body contribute to anxiety around sex, avoidance, loss of libido, and — in many cases — depression and relationship strain.

Research published in the Journal of Sexual Medicine confirms that women with vulvar lichen sclerosus experience a significantly greater degree of sexual dysfunction than healthy women — with reduced frequency of intercourse, lower satisfaction, and higher rates of sexual avoidance.

Can You Have Sex with Lichen Sclerosus?

Yes — but with important caveats that depend on the severity of your condition, how well it is controlled, and whether you have received appropriate treatment. Women with well-managed lichen sclerosus — where active inflammation has been suppressed and tissue health maintained — can absolutely have fulfilling, comfortable sex lives.

The key principle is this: lichen sclerosus that is left untreated or poorly managed causes progressive scarring that makes sex increasingly difficult or impossible. But lichen sclerosus that is actively managed — through a combination of medical treatment, regenerative therapies, and supportive care — can be controlled to a degree that preserves and, in many cases, restores sexual function.

At Elite Aesthetics, we assess each patient individually. For some women, the priority is pain relief and preventing further scarring. For others, the goal is to actively reverse existing damage and restore tissue quality, sensitivity, and elasticity using regenerative treatments such as the O-Shot and Morpheus8V.

Managing Lichen Sclerosus and Sex: Your Treatment Options Compared

There is no single approach to managing lichen sclerosus-related sexual difficulties. Here is how the main options compare — from self-management strategies to the advanced regenerative treatments available at Elite Aesthetics:

At Elite Aesthetics, Dr Shirin’s preferred approach for women with moderate to significant LS-related sexual difficulties is the combined O-Shot and Morpheus8V protocol — delivered in the same appointment for maximum synergistic effect.

How the O-Shot Helps with Lichen Sclerosus and Sex

The O-Shot uses platelet-rich plasma (PRP) derived from the patient’s own blood, injected into the clitoral and vaginal tissues. The concentrated growth factors in PRP stimulate tissue regeneration, collagen production, new blood vessel formation, and nerve repair — directly addressing the tissue damage that makes sex painful in lichen sclerosus.

The evidence is compelling. A 2024 pilot study involving 50 patients with vulvar lichen sclerosus reported significant improvement in sexual function, psychological wellbeing, and quality of life following PRP treatment — with the number of patients requiring maintenance steroid treatment reduced by 42%. At six months after the final injection, all patients reported being either satisfied or very satisfied with their results.

A further randomised controlled trial published in April 2026 in Obstetrics & Gynecology found that women treated with PRP demonstrated greater improvement in sexual function scores compared with a control group, with higher rates of patient-reported improvement and no serious adverse events.

Crucially, unlike topical steroids — which can cause irreversible thinning of vulval skin with prolonged use — the O-Shot actively strengthens and rebuilds tissue. It is not a suppressive treatment; it is a regenerative one.

Dr Shirin Lakhani (GMC: 4634863) is a UK Trainer for the O-Shot and has performed the procedure on many women with lichen sclerosus at Elite Aesthetics in Near London. Every O-Shot is a single treatment performed in our CQC-registered clinic, with the option to add Morpheus8V in the same appointment for enhanced results.

Who Is a Good Candidate for the O-Shot for Lichen Sclerosus?

The O-Shot is suitable for women with lichen sclerosus who are experiencing:

• ✅ Painful or impossible penetrative sex (dyspareunia or apareunia)
• ✅ Reduced sexual sensation or difficulty reaching orgasm
• ✅ Vaginal dryness and reduced lubrication
• ✅ Tissue fragility, fissuring, or scarring at the vaginal opening
• ✅ Narrowing of the vaginal opening
• ✅ A desire to move beyond steroid creams towards active tissue regeneration
• ✅ Good general health with no active infection or uncontrolled bleeding disorder

The O-Shot works best when lichen sclerosus is reasonably well controlled — ideally with topical steroid treatment managing active inflammation. Dr Shirin assesses every patient individually and will discuss the most appropriate approach at your consultation.

Practical Tips for Intimacy with Lichen Sclerosus

• Use a high-quality, pH-balanced lubricant every time — free from glycerin, fragrance, and parabens, which can irritate already-sensitive LS tissue.
• Apply your steroid cream as prescribed before and after sexual activity during flares — never skip your maintenance treatment.
• Communicate openly with your partner about what is comfortable and what is not — adjusting pace, depth, and position makes a significant difference.
• Consider positions that allow you control over depth and pressure, such as woman-on-top or side-lying positions.
• Allow time for arousal before any penetration — natural lubrication and tissue engorgement reduce friction and the risk of fissuring.
• Do not push through severe pain — if sex is consistently very painful, this is a signal that your LS needs better management, not that you should endure it.
• Seek specialist support — a pelvic floor physiotherapist working alongside your medical team can be invaluable for progressive desensitisation and dilator therapy.