MULTI-DISCIPLINARY INTERVENTION FOR LABIAL FUSION IN A CASE OF VULVAL LICHEN PLANUS.

Abstract

Vulvo-vaginal lichen planus is a very distressing and rare forms of non-venereal genital dermatoses. Erosive variants of Lichen planus often have a protracted course and has a higher risk of malignant transformation. This case was a 53-year- old woman, previously diagnosed with lichen planus on conservative treatment, who now presented with symptomatic labial adhesions and urinary complaints like urgency, frequency and poor urine stream. Clinical examination revealed normally developed labia majora, partially but extensively fused labia minora including the clitoral hood. Urethral opening was not visualised, while a small vaginal orifice was seen with no ulcerations. A multi-disciplinary team consisting of urologist and plastic and cosmetic surgeon dissected out the labial adhesions with the electrocautery and reconstructed the vaginal and urethral openings. Cystoscopy followed by urethral dilatation was done for urethral narrowing. Postoperatively, on following up the patient the adhesions were completely separated, and the area healed well. No recurrences were noted. Though aggressive management with topical steroids and other measures often improves symptoms on short term basis, few patients may require long term management by multi-disciplinary team to optimize the outcomes.