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A Doctor’s Advice: ‘Why Am I So Sore Down There?’

You may have lichen sclerosus.

As we age, our body changes. And sometimes these changes can make things we once loved doing — like riding a bike — feel a lot more uncomfortable. Postmenopausal women are at a higher risk for a condition called lichen scelrosus, which causes patchy, discolored, thin skin and typically affects the genital and anal areas. It isn’t contagious and cannot be spread through sexual contact — but it can still be mighty uncomfortable. See our expert’s tips on how to identify and treat it below.

Meet our expert

Barbara DePree, MD, is a gynecologist in private practice and director of Women’s Midlife Services at Michigan’s Holland Hospital. A Certified Menopause Practitioner, she is the founder of MiddlesexMD.com, an educational resource for women’s sexual health in perimenopause and beyond. To ask her a question, send an email to health@firstforwomen.com.

Q: I’m 58 and healthy. But recently, the skin outside my vagina and around my anus burns and is so thin, it tears and bleeds. Plus, exercising or riding my stationary bike makes the area even more sore and painful. What could this be?

A: I’m so sorry you’re experiencing this and suspect you may have lichen sclerosus (LS). The autoimmune inflammatory condition causes thin, wrinkled, shiny, white parchmentlike skin and intense burning and blisters, or the tearing and bleeding you describe. It’s common in menopause since a drop in estrogen can thin vulval skin, which may trigger LS. Unfortunately, exercise can worsen the symptoms — especially those that cause rubbing or friction, like biking or horseback riding.

Your doctor can confirm the diagnosis with a skin biopsy, which will also rule out other conditions like eczema or psoriasis. Although there’s no cure for LS, managing symptoms is key to avoiding genital scarring and other health issues linked to the condition. Your doctor will likely prescribe a steroid ointment that you can apply to the area daily or a few times weekly, as needed.

Regular use of the ointment will ease the soreness you’re experiencing during exercise too, but I can recommend a few additional strategies to help. First, consider opting for low-friction activities like walking or swimming while you’re waiting for the steroid cream to work. I caution against the use of anything else on the area (like petroleum jelly), which can cause the skin’s barrier to break down. Finally, when you exercise, wear loose-fitting clothing and underwear made of natural fibers, and try to shower immediately afterward using an unscented soap and drying the area thoroughly.

This article originally appeared in our print magazine, First For Women.

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