Lichen sclerosus in women

Although cases in pediatric and adolescent age are not rare, most cases develop during menopause and significant hormonal changes.

Over the years, the vulva progressively changes in appearance. The labia minora reduce until they disappear, the clitoral hood closes, trapping the clitoris in the fusion with the hood. The vulvar walls become progressively more sclerotic and rigid. The posterior commissure, or the lower part of the vulva, tightens, as well as the upper part. This results in vulvar stenosis. The tissues become thin, fragile, easily irritated, and therefore more predisposed to inflammation and infections.

The thin and fragile tissues become easily irritated, prone to itching and burning. Sometimes lichen causes pain, mostly due to tissue tears. The narrowing of the vulvar opening or stenosis initially causes difficulties in intercourse; often, it becomes impossible, and in cases of more advanced disease progression, it leads to partial closure and sometimes even total closure of the vulvar opening.

The state of chronic inflammation is aggravated by acute inflammation or infections, also due to prolonged contact of urine with the mucous membranes and difficulties in cleaning.

In many cases, there is hypercontractility of the pelvic floor muscles, worsening the pain.

Improve the aesthetics of the female genitalia in lichen sclerosus

The function and symptoms are much more important than the aesthetic appearance, however for many the loss of the labia minora, the disappearance of the clitoris and the sparse appearance of the tissues represents a further problem to face. Unfortunately, it is not easy to restore the original anatomy and even when restored it must always be considered that lichen sclerosis is a progressive autoimmune disease, therefore some benefits achieved must then be maintained with hydration, massage, rehabilitation of the pelvic floor and not letting the inflammation bring back the restored anatomical configuration.
In summary, a lot of experience on the part of the doctor and good will on the part of the patient are needed to maintain the results achieved. The clitoris can be exposed again, the clitoral foreskin restored, the labia minora can be partly detached from the labia majora.
The procedures are carried out in a day-hospital setting under sedation. Each procedure has a combined regenerative moment and surgical moment. Sometimes the regenerative one must be repeated every few months to maximize the quality of the tissues.

Only aesthetic improvement? No, even functional

Aesthetics and function must go together. When an aesthetic improvement is achieved, the tissues become more elastic because they stretch. Therefore, we never talk about a pure aesthetic result. Furthermore, the regenerative part is always a key point of the procedure. In summary, even if the objective is to improve aesthetics, tissue regeneration is always carried out.

The clitoris and lichen sclerosus

The clitoris is composed of two arms that originate in the vulva and a body called the glans covered by mucosa. The glans is the exposed part. The clitoral foreskin covers the glans but when it moves it allows it to be unhooded. Unfortunately, lichen sclerosus causes central fusion of the foreskin. This progressively determines the disappearance of the clitoris under the preputial “tent”. In some cases the condition is absolutely asymptomatic, in others there may be spontaneous pain or pain evoked by palpation or clitoral stimulation, especially when the clitoris is of significant size, its increase in volume during arousal can cause discomfort and pain. In some cases, sebaceous cysts can form, even large ones. Rarely the mucosa of the glans is directly attacked by Lichen.
So in most cases the glans is absolutely normal, but is hidden beneath the proportional tissue.

What to do?

The clitoral exposure procedure takes place with the utmost respect for sensitivity. The glans is gently exposed and the foreskin expanded. The tissue around the clitoris is treated with regenerative cell-rich fat preparations in order to restore tissue elasticity and reduce the possibility of recurrence.

How is it done? How long does it last?

It can be done under simple local anesthesia or with a little sedation. In expert, microsurgical hands, the procedure lasts approximately 40 minutes and is carried out as day surgery or outpatient surgery.

Restore the labia minora

Detachment of the labia majora and minor after they have fused and flattened is possible, but maintaining a projection is not a simple thing. Simple detachment almost never leads to good results and the healing process takes a long time. It is much better to resort to detachment and skin grafting to maintain the space that has been recreated. This procedure requires high skill on the part of the plastic surgeon and a lot of good will on the part of the patient to optimize the healing process and maintain the results achieved.
The advantage is not only the restoration of aesthetics, but also the gain in elasticity due to the addition of fabrics.