About YOUR Health: Lichen Sclerous and VBAC
Questions and Answers from the NWHN Women's Health Information Clearinghouse
Q: I have recently been diagnosed with lichen sclerosus. Can you tell me more about the disease and methods of treatment of the condition?
A: Lichen sclerosus is a chronic inflammatory skin disease that causes substantial discomfort. It is most common in adult women but also occurs in men and children. Women of any age can be affected, but it is most common in perimenopausal and postmenopausal women. While any skin site may be affected, lichen sclerosus of the genital and anal areas is most common, and is often associated with itching and burning. Early in the disease, small inflammations (or papules) are soft, pink, and slightly raised. In addition, progression to destructive scarring is common. The exact cause of lichen sclerosus is not known. It may be due to an autoimmune process, an injury, or may follow radiation therapy. Autoimmune disorders are caused when the body's natural defenses against foreign substances (antibodies) begin to attack healthy tissue.
The primary treatment for lichen sclerosus is steroid creams or ointments, sometimes mixed with testosterone. The ointment must be used long-term. There is no cure, but treatment usually alleviates symptoms. It is important that those with lichen sclerosus have it checked yearly by a health care practitioner, as it may be a risk factor for squamous carcinoma of the vulva.
Q. I had a c-section for my first child and am now pregnant again. Can I have a vaginal birth this time around?
A. A vaginal birth after Cesarean (or VBAC, pronounced vee-back) can be a safe and positive experience for many women. Up to 80 percent of women who have a cesarean birth can have a vaginal birth the next time. The practice of requiring repeat c-sections became popular as a way to avoid the rupture of the previous incision. However, the vast majority of women who now have cesarian births receive a low horizontal uterine incision, or "bikini cut", that poses little risk of rupture during labor. In fact, scientific evidence supports that if a woman has had a previous c-section with a low horizontal uterine incision, a vaginal delivery is as safe as a cesarean for the baby, and even safer for the mother.
There is also reason to believe that labor is beneficial to a baby, whether or not the ultimate method of delivery is vaginal or cesarean. A period of labor allows the baby to prepare for the changes to come. If your goal is to have a VBAC, you should speak with your health care provider about her/his philosophy regarding vaginal births after c-sections. You may want to ask whether your obstetrician offers a "trial of labor" to women who have had c-sections, and what percentage of those women deliver vaginally. Not all midwives do VBACs. If you have a midwife who does, you may want to inquire about her cesarean rate, as well as the arrangements that are made for complications. While few health care providers have statistics calculated, pay attention to how they respond to your questions. Seek out people who listen to your needs, take your concerns seriously, and offer information and support.