(182) Vulvovaginal Obliteration: A Severe Manifestation of Genitourinary Syndrome of Menopause

Introduction Genitourinary Syndrome of Menopause (GSM) affects over half of postmenopausal women and can progress to labial adhesion or vulvovaginal obliteration (VVO), a debilitating but underrecognized endpoint. Current literature consists only of case reports and small series, without a standardized staging system Objective We hypothesized that a structured classification could improve management. The objectives were to present the largest case series of postmenopausal vulvovaginal obliteration to date and to propose the first clinical staging system Methods We retrospectively reviewed 14 consecutive postmenopausal women with labial adhesion managed at a single institution between December 2018 and August 2025. Data included demographics, comorbidities, presenting symptoms, staging, interventions, and outcomes. A novel 5-stage classification system, integrating anatomical extent and functional impairment, was applied. Results The mean age was 76 years, with an average of 25 years since menopause and 22 years of sexual inactivity. None had prior hormone therapy. The majority (13/14, 92.9%) presented with advanced disease (stages III–V). Common symptoms included urinary retention (28.6%), post-void dribbling (28.6%), and weak urinary stream (28.6%). All advanced cases (n=13) required surgical lysis of adhesions; one stage II patient was managed conservatively. Initial estrogen-only maintenance resulted in recurrence (3/3 patients). Following protocol change, combined topical estrogen and vaginal dilator therapy prevented recurrence in all subsequent patients, with a mean follow-up of 24 months. Symptom resolution and quality-of-life improvements were universal. Conclusions This study presents the largest case series of postmenopausal VVO and introduces the first clinical staging system. Surgical lysis restores anatomy, but long-term patency requires combined estrogen and dilator therapy. Greater clinical awareness and standardized staging may facilitate earlier diagnosis, prevent progression, and optimize management. Disclosure No