A Technique for Vulvar Adhesiolysis for Patients with Lichen Sclerosus

Objectives: We present two surgical cases of patients with extensive labial adhesions due to lichen sclerosus. In the case of these two patients, the labial adhesions led to post-void dribbling, pain, and decreased sexual health and function. While high-potency topical steroids are the mainstay of medical management for lichen sclerosus, in patients with significant adhesions, lysis of labial adhesions under sedation should be considered to restore patency of the urethral and vaginal orifices and to release paraclitoral scarring. This video demonstrates a surgical technique for this procedure.

Methods: In this video we provide a stepwise video narrated demonstration of our technique for vulvar adhesiolysis in two patients with lichen sclerosus.

Clinical Relevance: Vulvar labial adhesiolysis should be considered in patients with vulvar lichen sclerosus refractory to medical management. This procedure can alleviate acute anatomic obstructive symptoms in afflicted patients and promote functioning and wellbeing.