Abstract Introduction Lichen sclerosus (LS) is a chronic inflammatory dermatosis that can cause vulvar sclerosis, adhesions, and architectural distortion, leading to dyspareunia and sexual dysfunction that severely impact quality of life. Scarring may involve the perineum, labia, clitoral hood, or perianal area, resulting in labial fusion or clitoral adhesion. Although topical corticosteroids are the standard therapy, they primarily control inflammation and symptoms; once fibrosis is established, reversal is difficult. Regenerative therapies have shown potential to enhance tissue elasticity and function. Carboxytherapy, involving subcutaneous or intradermal infusion of medical CO₂, stimulates microcirculation, collagen synthesis, and tissue regeneration. Extracorporeal shock wave therapy (ESWT) has also demonstrated benefits in fibrotic and sexual disorders, including Peyronie’s disease and female sexual dysfunction. Objective To evaluate the improvement of dyspareunia and vulvar scarring in a patient with LS and a postpartum perineal scar treated with carboxytherapy and ESWT, assessing sexual function using the abbreviated Female Sexual Function Index (FSFI). Methods A 46-year-old woman presented with dyspareunia due to a postpartum perineal scar and vulvar LS, confirmed by biopsy in 2022. The condition caused recurrent fissures despite ongoing corticosteroid and emollient use. Examination revealed preserved labia minora, complete clitoral phimosis (CIV Grade 3), perineal scar, and a vulvar pterygium. The patient underwent five sessions of carboxytherapy and three sessions of ESWT as part of a regenerative protocol. Evaluations included physical examination, photographic follow-up, and FSFI scoring, assessing desire, arousal, lubrication, orgasm, satisfaction, and pain. Results Clinical improvement was progressive. The postpartum scar became visibly softer, and tissue elasticity improved. After the fifth carboxytherapy session, minor debridement (requested by the patient) allowed complete clitoral exteriorization. Dyspareunia fully resolved, and the patient resumed pain-free sexual activity. The FSFI score increased from 17 at baseline to 24 after treatment, showing notable gains in arousal, satisfaction, and pain reduction. The patient expressed high satisfaction with both functional recovery and aesthetic results. No adverse effects were reported. Conclusions Carboxytherapy combined with extracorporeal shock wave therapy appears to be an effective regenerative option for vulvar scarring and dyspareunia secondary to lichen sclerosus and postpartum fibrosis. When associated with gentle debridement of clitoral adhesions, this approach promotes neovascularization and dermal remodeling, improving tissue flexibility, clitoral mobility, and sexual comfort. Regenerative gynecologic therapies may therefore represent a valuable alternative for women with chronic vulvar scarring, offering restoration of function and enhanced quality of life. Further research in larger populations is warranted to validate these findings. Disclosure No
Figueras et al. (Mon,) studied this question.