Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus

Abstract

IntroductionLichen sclerosus (LS) is a chronic inflammatory dermatosis, usually affecting the anogenital skin in women. This chronic inflammation can cause scarring of genitalia including narrowing of the introitus and phimosis of the clitoris. These architectural changes can lead to recurrent tearing during intercourse (vulvar granuloma fissuratum) and decreased clitoral sensation. Surgical correction of vulvar granuloma fissuratum (VGF) and clitoral phimosis can be performed, but there is little data on the patient satisfaction and complications following these surgical procedures.AimTo evaluate patient experience and outcomes in women undergoing surgical correction of scarring caused by anogenital LS.MethodsA retrospective chart review of patients at a vulvar disorders clinic was performed to identify women who had undergone surgical correction of clitoral phimosis or lysis of vulvar adhesions for VGF due to LS. Twenty‐eight women were contacted via telephone between 4 and 130 months postoperatively. An eight‐question survey was used to determine patient experience and outcomes.Main Outcome MeasuresAll participants completed an eight‐question survey to evaluate patient satisfaction with the surgery, effects on clitoral sensation, orgasm and pain with intercourse, postoperative symptoms or complications, and the presence of recurrent vulvar scarring.ResultsParticipants reported that they were either very satisfied (44%) or satisfied (40%) with the procedure. Of the women who experienced decreased clitoral sensation prior to surgery, 75% endorsed increased clitoral sensitivity postoperatively. Of the women who had dyspareunia prior to surgery, the majority of women reported having pain‐free sex (33%) or improved but not completely pain‐free sex (58%) after surgery. There were no complications or symptoms made worse by the surgical procedures.ConclusionsThis study shows high patient satisfaction and low complication risk associated with surgical correction of clitoral phimosis and lysis of vulvar adhesions for VGF caused by LS. Patients reported improvement in clitoral sensation and ability to achieve orgasm, as well as decreased dyspareunia. Surgical correction of vulvar scarring is a viable option to restore vulvar anatomy and sexual function in appropriate candidates with anogenital LS. Flynn AN, King M, Rieff M, Krapf J, and Goldstein AT. Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sex Med 2015;3:251–255.

<p>Vulvar Lichen Sclerosus: Current Perspectives</p>

“…Clitoral phimosis, scarring of the prepuce and/or labia majora to the glans clitoris, is a complication of vulvar lichen sclerosus that can cause significant morbidities including loss of clitoral sensitivity leading to secondary anorgasmia. [79][80][81][82][83][84] In addition, a smegmatic pseudocyst can develop in the space between the prepuce and clitoris which can lead to chronic inflammation and/or infection causing the need for lysis of clitoral adhesions. 79,83 Clitoral phimosis may be treated successfully through surgical intervention.…”

“…Of the four women who reported decreased clitoral sensitivity prior to surgery, 100% experienced increased clitoral sensitivity and orgasm post-operatively. 84 An additional complication many women with vulvar lichen sclerosus develop is introital stenosis. 48 For many women, narrowing of the introitus causes significant dyspareunia, sexual dysfunction, and vulvar granuloma fissuratum.…”

“…In a 2015 case series of 28 women, Flynn et al reported that sharp dissection of the introital scar tissue combined with post-operative clobetasol use and aggressive post-operative retraction of the incisions (without perineoplasty), improved dyspareunia in 85% of women who experienced pain with intercourse prior to surgery and clitoral sensitivity in 75% of women who experienced decreased clitoral sensitivity prior to surgery. 84 In addition, 84% of women who underwent surgery would recommend surgery to women with similar symptoms. 84 These studies demonstrate that women with clitoral phimosis, introital stenosis, and VGF secondary to LS can be successfully treated with minimally invasive surgical intervention.…”

“…84 In addition, 84% of women who underwent surgery would recommend surgery to women with similar symptoms. 84 These studies demonstrate that women with clitoral phimosis, introital stenosis, and VGF secondary to LS can be successfully treated with minimally invasive surgical intervention.…”

A Retrospective Case Series on Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions

“…6 More recently, studies on the management of clitoral adhesions have assessed efficacy and/or patient satisfaction, but only in the setting of a surgical lysis procedure and exclusively in patients who also had LS. 2,8,9 LS is a chronic, inflammatory dermatosis in the anogenital region typically found in pre-pubertal or postmenopausal women that causes skin thinning, whitening, wrinkling, itching, and pain (Figure 3). 9 Although LS is an important etiology of clitoral adhesions, they can also occur in women without LS.…”