The effect of chronic vulvar dystrophy on urinary continence in patients at climacterium

Abstract

Chronic dystrophy is the growth of abnormal skin on the vulva, its causes being lichen sclerosus, with thin vulvar skin lesions and squamous hyperplasia with thick tegument. Lichen appears as discolored, translucent irregular areas of skin on/around the labia especially in women at climacterium. It can cause from lack of clinical manifestations to intense itching and progressive vulvar pain. Squamous hyperplasia transforms vulvar skin thick with white elevations causing intense itching. We examined a number of 22 climacteric patients, aged between 52 and 73 diagnosed with vulvar dystrophy in the interval 2014–2016. Urinary incontinence was diagnosed in 90% of them: 36% presented stress urinary incontinence, 40% mixed incontinence (vulvar dystrophy being a factor in the continence impairment), while in 22% of the cases the main etiology of the disease was the severe alteration of the vulvar anatomy. The 5 cases presenting important distortion of the external genital organ anatomy included partial labial adhesion or complete labial fusion caused by chronic dystrophy and required surgical intervention. The etiology in the appearance of labial adherences is thought to be inflammation of the labia with denudation of the superficial layer which heals by fibrosis causing adhesions. Labial fusion in menopause is a rare condition which in addition to chronic dystrophy has other two risk factors: relative hyperandrogenism associated with lack of estrogens and chronic urinary tract infections (UTI). Regarding recurrent UTIs, they represent both a risk factor and a consequence of labial fusion, the urine dribbling through the labial adherence over the external urethral orifice and draining through the vagina. Labial fusion affecting urinary continence is an uncommon phenomenon in postmenopausal women. The prognosis is good with surgical treatment, while estrogen and corticosteroid topic application should be used as prophylaxis for recurrence.