TOPLINE

Patients with vulvar lichen sclerosus who underwent lysis of vulvar adhesions experienced significant reductions in sexual distress and improvements in sexual function, with more than 80% reporting decreased distress and nearly 90% noting at least 50% improvement in pain with intercourse.

METHODOLOGY

• This pre-post intervention mixed-methods cohort study evaluated outcomes of lysis of vulvar adhesions surgery in patients with biopsy-confirmed vulvar lichen sclerosus in remission at 3 urban vulvar disorder clinics from December 2013 to January 2025.
• A total of 86 patients (median age, 48.2 years) completed preoperative and postoperative assessments, including the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and a 20-item postsurgical outcome questionnaire.
• Surgical indications included clitoral pain, recurrent smegmatic pseudocyst, decreased clitoral sensation, pain with vaginal penetration, or psychological distress from vulvar scarring.
• Procedures addressed clitoral phimosis through dorsal prepuce incision and adhesion lysis, and introital stenosis through vertical or horizontal incision of restrictive tissue bands, without suture placement.
• Researchers evaluated the effect of surgical intervention on sexual dysfunction, sexual distress, and patient satisfaction. The mean follow-up duration was 4.35 years.

TAKEAWAY

• FSDS-R scores decreased significantly from 30.2 preoperatively to 16.6 postoperatively (P < .001), with 82.4% of patients (61 of 74) reporting improved sexual distress and 43.2% (32 of 74) moving from scores indicating significant distress to below the threshold.
• FSFI scores improved from 15.0 preoperatively to 22.7 postoperatively (P < .001), with 38.03% of participants (27 of 71) changing from scores meeting criteria for sexual dysfunction to scores above the threshold postoperatively.
• The pain subsection of the FSFI increased from 1.55 to 3.79 (P < .0001), with arousal, lubrication, and satisfaction domains all achieving minimal clinically important differences of at least one.
• Among 86 participants who completed the 20-question postsurgical outcome questionnaire, 93% were satisfied with the procedure, and 95.3% suggested that they would recommend the surgery to others.
• Among patients reporting preoperative dyspareunia, 89.8% noted at least 50% improvement in pain, and 86.3% of those with decreased clitoral sensation preoperatively reported increased sensitivity postoperatively.

IN PRACTICE

"Although a minority of patients experienced complications or required revision surgery, the overall findings reinforce the effectiveness of surgical interventions for symptomatic vulvar lichen sclerosus-related scarring," the authors wrote. "These outcomes highlight the importance of individualized preoperative counseling and setting realistic expectations of outcomes to ensure optimal results and long-term satisfaction."

SOURCE

The study was led by Jill M. Krapf, MD, MEd, Center for Vulvovaginal Disorders Florida, Tampa, Florida. It was published online on July 30, 2026, in O&G Open.

LIMITATIONS

The study was limited by possible recall and response biases. Natural age-related declines in sexual function could have affected outcomes. Findings reflected outcomes from specialty practices with extensive experience in vulvar lichen sclerosus, which may limit generalizability to surgeons with less experience in this population.

DISCLOSURES

The study did not report specific funding. Krapf declared being a consultant for AbbVie, Evvy, and Pelva Health and is a medical writer for UpToDate. Another author declared being a consultant for AbbVie, Dare Bioscience, Leo Pharmaceuticals, and Nuvig Therapeutics, receives research funding from Stratpharma AG, Merz, and the National Vulvodynia Association, and serves on the Board of Directors of the Gynecologic Cancer Research Association. The other authors did not report any potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.