Surgical Treatment for Clitoral Phimosis and Vulvar Adhesions in Lichen Sclerosus

Lichen Sclerosus and Its Impact: What You Need to Know

Lichen sclerosus (LS) is an inflammatory skin condition that primarily affects the skin around the vulva and anus. It can cause persistent itching, irritation, discomfort, and difficulties with urination or sexual function. While LS is a persistent condition, it is manageable with proper treatment, and early diagnosis is essential to preventing complications and maintaining quality of life.

For many, consistent treatment can significantly ease symptoms and slow the progression of LS. However, if left untreated, scarring can occur, leading to lasting changes in vulvar tissue. Over time, this may cause issues such as thinning of the labia, narrowing of the vaginal opening, and clitoral phimosis (a condition where the skin over the clitoris becomes stuck). Another potential complication of LS is vulvar granuloma fissuratum (VGF), which occurs when persistent inflammation causes tears in the vulvar tissue.

Despite these potential complications, early and ongoing management can help preserve tissue health and function, reducing the risk of severe scarring.

The first-line treatment for LS is high-potency corticosteroid creams, such as clobetasol, which help control inflammation and prevent further scarring. While these treatments are highly effective in managing the condition, they cannot reverse scarring that has already developed. This is why early intervention and long-term management are so important. When scarring begins to affect sexual function, urination, or daily comfort, surgical intervention may be an option to restore function and improve quality of life.

A 2015 study published in The Journal of Sexual Medicine examined the effectiveness and patient satisfaction of surgery for clitoral phimosis and VGF. The research explored whether surgical procedures could help improve sensation, sexual function, and pain relief in affected individuals.

Clitoral Phimosis and VGF: How They Affect the Body and What to Do

Clitoral phimosis occurs when scar tissue causes the clitoral hood (the thin fold of skin that protects the clitoris) to adhere to the glans (the visible tip of the clitoris), either partially or completely. This can lead to changes in sensation and discomfort that may feel confusing or distressing.

Some individuals with clitoral phimosis may experience:

·      Changes in or loss of clitoral sensitivity

·      Discomfort or pain during sexual activity

·      Difficulty achieving orgasm

·      Buildup of smegma (a natural body secretion), which can sometimes cause irritation or infection

Similarly, vulvar granuloma fissuratum (VGF) is a complication that develops when chronic inflammation weakens the skin, making it more prone to scarring and tears.

For those affected, VGF may cause:

·      Pain with penetration, including during sexual activity, tampon use, or medical exams

·      Recurring tearing, which can take longer to heal

·      Inflammation and discomfort that may affect daily movement or urination

Both clitoral phimosis and VGF can deeply impact physical comfort, emotional well-being, and overall quality of life. If you’re experiencing symptoms, please know that your concerns are valid, and support is available. Early recognition and treatment can help relieve symptoms and restore comfort, function, and confidence.

How Is Surgery Performed?

When LS causes pain, discomfort, or makes everyday activities difficult, surgery may be an option to help relieve symptoms and restore function. While medications like corticosteroids can help manage inflammation and slow the progression of scarring, they can’t reverse scarring that has already formed. In cases where scarring affects sensation, sexual function, or causes repeated tearing, surgery may provide relief.

Surgery for Clitoral Phimosis

Clitoral phimosis happens when scar tissue causes the clitoral hood to stick to the clitoris, which can lead to reduced sensitivity, discomfort, or difficulty with arousal. The surgical procedure is minimally invasive and focuses on freeing the clitoral hood so it can move more naturally.

It involves:

·      Gently separating the scar tissue using a tiny medical tool designed for delicate procedures

·      Making a very small incision (about 5mm) on the upper part of the clitoral hood to help release the adhesions

·      Ensuring any remaining scar tissue is carefully released to allow better movement and improved sensation

·      Applying a prescription ointment after surgery to help with healing and reduce the risk of new scar tissue forming

Surgery for Vulvar Granuloma Fissuratum (VGF)

When VGF causes persistent discomfort, a minor surgical procedure can help by:

·      Gently removing the scar tissue to relieve tightness and pain

·      Using a special solution to stop bleeding and promote healing

·      Encouraging gentle movement and stretching after surgery to help prevent the scar from returning

Recovery and Aftercare

After surgery, doctors usually recommend a healing plan that may include:

·      Applying a prescription ointment to aid healing and reduce inflammation

·      Gently stretching the area (as advised by your doctor) to prevent the scar tissue from coming back

·      Regular follow-ups with a healthcare provider to ensure proper healing

·      Working with a pelvic floor physical therapist to improve tissue mobility, reduce muscle tension, and support lasting relief

The goal of surgery is to improve comfort, function, and overall quality of life. If you’re struggling with symptoms and wondering if surgery is the right option for you, speaking with a knowledgeable provider can help you explore the best treatment plan for your needs.

Surgical Outcomes: Was It Successful?

In this study, 25 women who underwent surgery were surveyed to assess their satisfaction and symptom improvement.

Key Findings:

·      84% of participants said they would recommend the surgery to others experiencing similar symptoms

·      75% of those with reduced clitoral sensation reported improved sensitivity after surgery

·      76% of participants with orgasm difficulties reported improvement, with 29% returning to normal function

·      76% of those who had pain with intercourse before surgery reported relief, and 31% became completely pain-free

·      While most participants reported positive results, 32% of patients experienced some level of recurrent scarring, emphasizing the importance of ongoing postoperative care to maintain surgical benefits

What This Means for Individuals with Lichen Sclerosus

This study suggests that surgery can be beneficial for individuals with significant scarring from LS, particularly those experiencing:

·      Sexual dysfunction (loss of sensation, pain with intercourse, difficulty achieving orgasm)

·      Pain due to restricted vaginal opening, making penetration difficult or impossible

·      Recurrent infections or irritation

·      Urinary dysfunction caused by adhesions restricting normal flow

However, it’s important to recognize that:

·      Surgery does not cure LS—it only addresses existing scar tissue.

·      Postoperative care is essential to help prevent scarring from returning

·      Not every patient with LS requires surgery—many can manage symptoms effectively with medication, pelvic floor physical therapy, and ongoing care

For those considering surgery, consulting with a pelvic floor physical therapist and a vulvar specialist can help determine whether conservative management or surgical intervention is the right choice.

Final Thoughts: Is Surgery the Right Choice?

While LS is a persistent condition, surgical intervention can provide relief in cases where scarring is severe enough to impact daily life, sexual function, or urination.

If you are experiencing ongoing pain, discomfort, or functional challenges related to LS scarring, discussing all available treatment options with a healthcare provider—including topical treatments, physical therapy, and surgery—is the best way to determine the most effective plan for your unique needs.

This study highlights the importance of a multidisciplinary approach, ensuring that patients receive both effective treatment and long-term management strategies to maintain their results.

Key Takeaways

·      Surgical correction can improve symptoms of LS-related scarring, especially for clitoral phimosis and VGF

·      Most participants in the study were satisfied with their results, reporting improvements in sensation, sexual function, and pain relief

·      Postoperative care, including corticosteroid use and gentle stretching, is crucial to preventing recurrent scarring

·      For individuals struggling with severe LS symptoms, surgery may be a life-changing option, but it should always be discussed with a specialist to determine the best approach

References

Flynn AN, et al. (2015). Surgical correction of clitoral phimosis and vulvar adhesions in Lichen Sclerosus: Patient satisfaction and outcomes. Sexual Medicine, 3(4), 251-255.

Note:
This blog is for informational purposes only and does not provide medical advice. It is not intended to diagnose or treat any medical condition. Please consult your healthcare provider before making decisions about your health or treatment options.