Does Stress Make Lichen Sclerosus Worse?
The exact cause of lichen sclerosus (LS) is unknown. It is believed to be autoimmunity that causes lichen sclerosus as many of the other autoimmune disease are seen in patients who have lichen sclerosus.
We cannot tell exactly whether stress causes lichen sclerosus or not, as there is no evidence of it. However, the urinary and sexual dysfunction caused by lichen sclerosus gives rise to anxiety, depression and stress. This stress may also precipitate flareups of the disease affecting the quality of life. So, as you see it’s a vicious cycle even though there is no hard proof to prove this theory this can be one possibility.
Stress and lichen sclerosus are interconnected as lichen sclerosus leads to stress:
In females
- Dyspareunia – painful sexual intercourse
- Urinary obstruction
- Secondary infection of the ulcerative lesions
- Secondary infection due to the steroid usage – steroid decrease the immunity therefore one can be more prone to infections
- Risk of malignancy – it’s rare but some studies say there is a 5% risk of developing squamous cell carcinoma of the vulva.
In males
- Painful erections
- Urinary obstructions
- Phymosis – inability to retract the foreskin due to scar formation
- Risk of malignancy – development of squamous cell carcinoma of the penis. This is very rare compared to the vulval carcinoma
- Extra genital complications
- Cosmetic concerns
How Does Lichen Sclerosis Cause Anxiety and Depression?
The above mention complications are the main cause for the stress and anxiety. Painful sexual intercourse, fear of lichen sclerosus can be contagious and you will make the partner also sick will reduce the sexual pleasure of a couple. This will cause marital problems and other family issues. Invariably, these problems will cause stress and anxiety. If this continues, it can lead to depression.
The urinary symptoms such as burning sensation when passing urine, incontinence (the urge to pass urine frequently) and urinary obstruction can also lead to stress and anxiety.
Young men and women will fear in having relationships with other partners and this will create more negativity in them. This will affect their personal and social life.
A study done on forty five cases of lichen sclerosus from 2000-2008, both men and women were included in this study. According to the results 16% of patients were worried about the possibility of infecting their partners with lichen sclerosus, despite the counseling about the disease. 27% felt that the condition’s cosmetic appearance may affect their libido and sexual life. There was some moderate to severe anxiety in 58% and 27% had depression. 19% of patients had insomnia (sleep disturbance) and 23% of them had stress. 11.5% were worried about starting a new relationship. These results show that lichen sclerosus has a huge impact on the mental health.
A study done in 1997 showed lichen sclerosus cases has effects symptomatically impinging on sex, leisure activities and sleep and they had a high score in global mood scale. In addition, this study revealed 56% of lichen sclerosus patients had chronic stress and 33% of cases were probable psychiatric cases and had severe effect on their sexual relationship.
Conclusion
The exact cause of lichen sclerosus is unknown. There is a possibility of it being an autoimmune disease. There are no evidence to tell that lichen sclerosus is caused by stress. However, stress can trigger the immune system and cause overactive immune system. However, lichen sclerosus can give rise to stress, anxiety and depression. This can precipitate flareups of disease and can act as a vicious cycle. The main reasons for the stress and anxiety in these patients are pain and discomfort associated with lichen sclerosus, the sexual dysfunction, loss of libido due to pain and cosmetic effect and fear of infecting the partner. These problems can lead to marital and family problems, social problems and can also affect the quality of life. This can lead to stress, anxiety and depression.
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