What is lichen sclerosus?

Lichen sclerosus is a disease of the skin of the genitals. In the male it can affect the foreskin, the glans and in the most severe cases all the skin of the penis and the inside lining of the urethra (= the waterpipe). The causes responsible of lichen sclerosus are still not fully understood but it is now believed that maceration of the skin caused by pooling of urine, recurrent skin infections, and the presence of predisposing factors such as diabetes and low testosterone levels might be linked to the formation of lichen sclerosus. 

Typically, the skin affected by lichen sclerosus becomes thicker, inelastic and tends to become white. As the skin is not elastic, it cracks during sexual activity and this may cause pain, itching and bleeding. When affected by lichen sclerosus, the foreskin becomes unretractable in a clinical picture also known as phimosis. 

As it becomes impossible to retract the foreskin to clean the corona and the glans (=the head of the penis), hygiene becomes poor and patients may suffer from recurrent urinary tract (=the waterwork) infections. If the lichen sclerosus affects the urethra, this can cause narrowing of the urethral tube and urination can become challenging.
Lichen sclerosus always originates at the level of the glans and the foreskin and then propagates towards the base of the penis and/or the urethra.

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