Lichen sclerosus: Since you don't have significant symptoms, you may not have treatment. But you should consult a dermatologist.
Topical testosterone was mainstay of treatment for female genital lichen sclerosus for decades. More recent studies suggest it may not be any more efficacious than placebo.
Systemic retinoids have been useful in limited studies with isotretinoin, etretinate, and acitretin. Topical corticosteroids, especially in the superpotent class, have been found to be useful in genital lichen sclerosus in both sexes and in all age groups. These have been used long term (weeks to months) or daily, without significant adverse cutaneous effects, although patients should always be monitored regularly for adverse effects (especially atrophy of nearby uninvolved areas).
Therapy with tazarotene (Tazorac) off label for this medication in this location and for this indication. Especially in genital and other occluded areas, short-contact therapy is used, in which the gel (or cream) is initially applied for 15 min and washed off. Every 2-3 wk, the time applied may be increased by about 15 min until either therapeutic effect or limiting adverse effects are noted. If a patient is applying the medication for 3 h or more, they may consider leaving the medication in place. For extragenital lichen sclerosus, this may be applied and left in place. This may be done in conjunction with topical steroid use.
A pregnancy test
is recommended before starting therapy, and the drug is category X (contraindicated). Tazarotene may be irritating and is not likely to be tolerated on open and denuded areas.
Systemic administration of the vitamin D analogs calcitriol and calcipotriene (Dovonex, Vectical, Taclonex [with topical corticosteroid]) has been shown anecdotally to be effective for generalized morphea. While not universally effective, topical forms of this category have helped some patients with localized sclerotic diseases. They can be irritating in genital and occluded areas and may require alternate-day therapy. They are usually not used as monotherapy for sclerotic disorders but, rather, are usually combined with topical corticosteroids. Daily to twice-daily application is suggested. Use with caution in patients with compromised renal function, and prolonged use of large amounts warrants laboratory monitoring (with particular attention to serum calcium values). Pediatric dosing is the same as adult dosing.
Shrinking clitoris and loss of orgasm: Before using supplements, you should first have a discussion with your doctor.
therapy. Placing estrogen directly into the vagina
soothes vaginal tissue, and allows the secretions necessary for comfortable sex and possibly even an increase in sexual desire. Unlike oral estrogens that carry some cancer risks, estrogens applied locally to the vagina are generally safe. They are available as suppository tablets, creams, or "rings," which sit inside the vagina and give off small doses of the hormone over time.
Vitamin E. When used locally in the vagina it can help rehydrate tissue and may possibly increase sensation. No need for a prescription here; just stick a pin in a vitamin E capsule and apply to the vagina several times a week, even if you're not having sex. And be sure to use a lubricant when you are having sex – either vitamin E or a commercially prepared product such as K-Y Jelly or Astroglide if you have enough natural lubricant.
Zestra. A small, placebo-controlled trial published in the Journal of Sex and Marital Therapy in 2003 showed that when used as a genital massage oil, this proprietary blend of botanicals (including borage seed and evening primrose oils, Angelica root and vitamins C and E) provided a statistically significant increase in arousal, desire, genital stimulation, ability to orgasm, and pleasure, in 20 women with or without sexual desire problems.
ArginMax. In a study of 77 women, a controlled double blind study found the nutritional supplement ArginMax increased sexual desire and satisfaction in more than twice the number of women taking placebo.