Itch, pain from autoimmune disease
A change in texture of the vulval and perianal skin plus apparent bleeding into the vulval or labial epithelium will be noticeable.
The epithelial changes have a pale background due to laying down of collagen in the upper dermis. The bleeding may have occurred during intercourse but it is most likely due to trauma from scratching. The underlying condition is lichen sclerosus, an autoimmune disease with no known precipitating cause. It can cause considerable discomfort and sometimes loss of the labia with narrowing of