040: Lichen Sclerosus Help With Diet And Physical Therapy w/ Dr. Jessica Drummond

Many clients come to me, too embarrassed to talk about lichen sclerosus. Today, I am hoping that my guest and I can remove some of the taboo around the topic, as well as share some help for those struggling with the condition (and others like it).

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My guest today, Dr. Jessica Drummond, DCN, CNS, PT, NBC-HWC, Founder of the Integrative Women’s Health Institute, is passionate about empowering women who struggle with chronic pelvic pain conditions and hormonal imbalances, and female athletes, and supporting women’s health and wellness professionals globally.

She has two decades of experience working with women using physical therapy and functional nutrition, and teaching her colleagues, from an integrative, evidence-based, and conservative perspective.

Join us as we talk about lichen sclerosus, as well as lichen planus and lichen simplex chronicus, three skin conditions that typically affect vulvar skin.

Have you used physical therapy or nutrition changes to manage lichen sclerosus? Tell me about it in the comments!

 

In this episode:

  • What is lichen sclerosus, and is that different from lichen planus, or lichen simplex chronicus?
  • Are these infections or autoimmune conditions?
  • How can physical therapy help women with these conditions?
  • Are there nutrition or lifestyle strategies that can help women with these conditions?

 

Quotes

“And there's really two main things that physical therapy can help with when it comes to Lichen Sclerosus and Lichen Planus. One is just relaxation, mobility, flexibility of the pelvic floor musculature and surrounding fascia tissues…Secondarily, as I said before, the skin itself can begin to really tighten up and tense up and close off the opening of the vaginal canal and also maybe scar in and around the clitoris and labia minora (internal labia). And that can be painful for intercourse clearly. ” [4:43]

“Anything that's going to both calm inflammation generally and heal the barrier between the digestive system and the immune system (which is the lining of the small intestines), from a nutrition standpoint can help heal lichen sclerosus because we're really reversing autoimmunity at the very root.” [9:15]

 

Links

Find Jessica online

Check out Jessica's book: Nutrition for Relieving Pelvic Pain: Fueling the Patient/Practitioner Healing Partnership

Follow Jessica on Twitter ǀ Facebook ǀ Instagram ǀ LinkedIn ǀ YouTube ǀ

Jessica's hormone webinar

 

Lichen Sclerosus Help With Diet And Physical Therapy w/ Jessica Drummond FULL TRANSCRIPT

Jennifer: 00:02 Hi everyone. Welcome back to the Natural Skin Show. I've got another dear friend of mine who's joining me today to talk about a topic. We have actually discussed this before, but we're coming at it from a different perspective this time. We're going to dive into Lichen Sclerosus again, but I want to introduce my guest. Her name is Dr Jessica Drummond and she is the founder of the Integrative Women's Health Institute. She's passionate about empowering women who struggle with chronic pelvic pain conditions and hormonal imbalances as well as female athletes and supporting women's health and wellness professionals globally. She has two decades of experience working with women using physical therapy and functional nutrition and teaching her colleagues from an integrative based and conservative perspective. Thanks so much for joining us Jessica.

Jessica: 01:03 It's my pleasure.

Jennifer: 01:03 I am very excited to talk about this because you look at this from a different perspective. My clients that have had lichen sclerosus, it's like they struggle in silence, ashamed of this issue that they're dealing with. And it is to some degree, very much a skin condition. And it's something that oftentimes they won't come to me as the outright issue. There'll be like, oh, and by the way, I have this thing, I don't know if you know what it is. So can you talk a little bit about what Lichen Sclerosus is and how it differs from some of these other conditions that from a just a name standpoint look kind of similar?

Jessica: 01:50 So Lichen sclerosus and Lichen Planus and Lichen Simplex Chronicus they sort of have different underlying issues, but all of them essentially present on the vulvar skin. And they also can be in the mouth, especially Lichen Planus can be in the mouth. And as you said, it's a skin condition that there is some mystery to it. Lichen Simplex Chronicus is really just an itchiness. It's an itchiness that can keep women up at night, but it's not an infection. It's like an irritation inflammation to the skin. Lichen planus and Lichen Sclerosus, from my perspective, the key factors that they both have an underlying autoimmune component.

And so the good news is is that while conventional medicine is kind of limited to topical creams and steroids and things like that, which are necessary in some cases to use right away to make sure that we don't, the disease process doesn't progress and you know, it's on the vulva. So it can actually sort of shrink the opening of into the vaginal canal, which can be really painful and obviously make sex painful and make using tampons painful, and things like that.

But from the inside out, while that's going on to kind of initially limit the progression of the disease and treat the symptoms, we want to think of this from an autoimmune picture and from a physical therapy standpoint, we want to consider that anytime you've got such intense irritation, whether it's itching or inflammation or pain in the vulva, in and around the vulva, your pelvic floor muscles are probably gonna tighten up, right? So if you had like a lot of really irritated skin on your scalp or your neck or your throat, you probably kind of generally even subconsciously tighten up the muscles of your neck and shoulders. Right. And it's kind of the same thing in a vulva vaginal perspective.

You know, if you know that every time you go to have sex or you put on tight jeans or you sit in a chair a certain way or you're going to have to be sitting for a while and you know that skin is going to be like feeling really uncomfortable and burning and itching, you know your whole pelvic floor musculature and surrounding area are going to be sort of tensing up for protection.

Jennifer: 04:11 And so from a physical therapy perspective, is there a way to help with these conditions because obviously their skin related and there somebody is probably going wait physical therapy, how, how, how can that help? So tell us a little bit, cause that's kind of your specialty.

Jessica: 04:30 Yeah. So from a physical therapy perspective of what you can do, first of all, you need to find a physical therapist who has been trained as an, as an expert in seeing these conditions in pelvic physical therapy.

And there are really two main things that physical therapy can help with when it comes to Lichen Sclerosus and Lichen Planus. One is just relaxation, mobility, flexibility of the pelvic floor musculature and surrounding fascia tissues. Because if, like I said, you're walking around with like a tight pelvic floor all the time, you know, think about if your hand was stuck in this tight fist position all the time, would there be good blood flow for healing? No. You know, there wouldn't be good nervous system conduction, you wouldn't have, you know, you need flow of and movement in muscles, tissue, fascia for good circulation, good lymph flow, things like that. And if we think about this as being potentially an autoimmune related condition, we can't bring the biochemical healing until we have biomechanical movement in the, in the vagina, vulva, pelvic floor region. Right?

So that's one way that physical therapy can help. Quite a bit. Secondarily, as I said before, the skin itself can begin to really tighten up and tense up and close off the opening of the vaginal canal and also maybe scar in and around the clitoris and labia minora, internal labia. And that can be painful for intercourse clearly. So physical therapy can also help with recommendations for lubricants that don't have endocrine disruptors. We can use dilators. Actually, I've got some right here.

So as I said, you can, the skin around the vulva are openings. I have my little model here and this whole opening area here to the vagina can basically close up from the irritation and inflammation in the skin itself. So dilators are like small silicone, they have plastic ones. There are different kinds that you literally put in vaginally and then practice relaxing the skin tissue musculature of the pelvic floor and external vulva. So that, you know, this is a pretty narrow one. It's about a little bit like double the size of one of my fingers, but they go up to, you know, more human size as that tissue begins to stretch out. So we use vulva vaginal dilators to stretch the tissue but very gently and you can stretch the tissue, move it and get the vulvar tissues more comfortable with having something inserted like a speculum or a tampon or ultimately during intercourse.

So those are the ways that physical therapy can help. And then from a nutrition standpoint, we're really thinking of this, these conditions very similarly that we would with any other autoimmune condition.

Jennifer: 08:25 And so let's talk about that because you and I have both had this gone through this lovely process of learning a ton about nutrition and passing the CNS and everything. So talk to us a little bit about your experience from a nutritional perspective in helping clients with these issues.

Jessica: 08:44 Yeah. So from that standpoint, it really starts with the digestive function. So is your client, you know, really chewing her food, is there any problems with intestinal, leaky gut, you know, issues because that's directly related to triggering the immune system to be hyper responsive, you know, why is the immune system hyper responsive to these tissues? Well, something's going on.

It could be related to what women are eating. And so we do, we can do elimination diets, we can do strategies to heal the leaky gut, like adding zinc, adding glutamine, adding bone broth. Anything that's going to both calm inflammation generally and heal the barrier between the digestive system and the immune system, which is the lining of the small intestines from a nutrition standpoint can help heal lichen sclerosus because we're really reversing autoimmunity at the very root.

Jennifer: 09:43 And so for somebody that comes to you with these types of issues, is there a specific type of diet or any initial first steps that you might make recommendations on as far as just food or lifestyle that can be helpful?

Jessica: 10:00 Yeah. So stress is certainly a factor because stress can increase the permeability. So that barrier between the digestive system, like your small intestines are where most of your nutrients are absorbed and where the barrier is responsible. The lining of the intestines are responsible for keeping things from being exposed to your immune system that shouldn't like bacteria. You know, none of us are eating sterile food, right? We all live in environments where bacteria exists. So the process I go through is starting with is the digestive functioning working? Are you breaking down your food adequately? So that means are you chewing enough? Is there enough acid in the stomach to really break down proteins? Or are you getting chunks of proteins that are too big that are irritating the lining of the small intestine. Then to take the stress off the small intestine, we do for week assessment of what we have, what's called the elimination diet. Although I don't really have to think of it that way cause I don't want it to feel restrictive because there are lots of delicious and healing foods you can eat.

But it is helpful to eliminate at the very least dairy, gluten, sugar, soy, eggs, and sometimes a few other things depending on what else is going on just for those three to four weeks. But doing it really consistently for those three to four weeks so we can give the immune system time to calm down. But the more important thing is to make sure we're adding the nutrients that the immune system needs to heal and the digestive lining needs to heal. So zinc, glutamine, magnesium, you know, my clients are slowly but surely, you know, eating eight to 10 servings of vegetables. We've got to get the anti-inflammatory nutrients in, you know, and things like turmeric and ginger and rosemary and oregano, all these sort of calming culinary herbs and spices and things that calm the lining of the digestive system, like chamomile or things like that.

So it's an elimination diet in the short term to see which foods are irritating that individual person and depending on the person and what they've been eating before and what they already know they're sensitive to. And if they have any bladder issues or other pain, we design that elimination diet pretty individually. But there are some places you can start. Even if you just start with those four or five things, take the pressure off and focus even more than that on adding the nutrients. Do that really consistently for one month while you're also noticing like, what am I really stressed out? How does my stress impact the pain and the irritation on my vulva? You know, we often don't think that these things are at all related. We don't really think about our vulva being related to our stress level, but as we start to track it, and I like to have my clients walk around with a little tiny journal where they actually pay attention to not what irritates them, but what's making them feel better.

So when people have chronic pain and chronic irritation conditions, every time you show up at, you know, a doctor or a clinician, it's like, what's your pain level? How long have you been in pain? How chronic is you're pain, you're always thinking about in monitoring your own pain. And to me that's not the best way from a pain science perspective to calm the brain into thinking about being in less pain. So instead of focusing on the pain, the little journal is about really focusing on when your pain is a little less. Who were the people you're around? What kind of a night's sleep did you have the night before? You know, did you have fresh salmon and vegetables for dinner? And then you woke up and you had a little less pain. So starting to pay attention to when the pain is less helps to give us information about what is healing for you.

Jennifer: 13:50 That is a really cool perspective and it's different than you're right. It's a very different way to assess and to monitor and experiment, so to speak. I also love that you're inviting the listeners who are struggling with this. And I recognize that this isn't everybody, but I would suspect that more women may have this issue than either realize or willing to admit to it. My experience has been that there's an embarrassment around it and I wanted to share these interviews because I think that there's not, from my understanding, there's really not a lot, a whole lot out there to help women with this condition. And I think it's important that you realize that it's tied to other things like the stress, the food that you eat, what's going on in your gut. It's essentially, it's all one track. More or less,

Jessica: 14:47 It is. And I think the pelvic aspect of it is too, because a lot of times, because the pelvis itself, you know, this bowl is really pretty small. So if you have endometriosis or painful bladder syndrome or Vulvodynia, any other kind of pelvic pain condition, you might have inflammation and you know, autoimmune kinds of pictures of Lichen Sclerosus or Lichen Planus around your vulva. And there can be some coexistence of these various different pelvic pain conditions. So sometimes you're not dealing with just one. And so we really have to take that holistic approach to unwind the whole picture.

Jennifer: 15:25 That's really neat. I'm so glad that you were able to share about this because I don't know anybody else who can, I love that you're such an expert in this area and that you do meld the physical therapy piece with the nutrition piece and looking deeper and trying to help people from a root cause perspective. Figure this out. It's really great. So, Jessica, where can everyone find you?

Jessica: 15:50 So the website is integrativewomenshealthinstitute.com and you can find me and everything else there.

Jennifer: 15:58 Yes. And I will make sure that in the show notes there is Jessica's website and all of her social media. So it's super easy to find. And then you also have a hormone balance Webinar that you're happy to share with everybody. So I'll put a link to that so that everyone can go and check that out if they feel that this is really an issue that they're struggling with and you love to, you want to get this put to bed so you can get on with life and not have to think about it anymore. Thank you so much for joining us. I really appreciate it.

Jessica: 16:31 Thank you so much for having me.

 

“And there's really two main things that physical therapy can help with when it comes to Lichen Sclerosus and Lichen Planus. One is just relaxation, mobility, flexibility of the pelvic floor musculature and surrounding fascia tissues...Secondarily, as I said before, the skin itself can begin to really tighten up and tense up and close off the opening of the vaginal canal and also maybe scar in and around the clitoris and labia minora (internal labia). And that can be painful for intercourse clearly. ”