(036) Effects of Lysis of Vulvar Adhesions and Clitoral Phimosis Surgery on Sexual Dysfunction and Patient Satisfaction in Women With Vulvar Lichen Sclerosus: A Prospective Pre-Post Intervention Cohort Study

Abstract Introduction Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin condition primarily affecting the anogenital region, leading to scarring, sexual dysfunction, and increased risk of squamous cell carcinoma. The pathophysiology involves immune-mediated fibrosis, causing architectural changes and functional impairment. Women with VLS frequently present with vulvar pain, pruritus, irritation, voiding dysfunction, and sexual dysfunction, with progressive scarring leading to clitoral phimosis, labial adhesions, and introital stenosis. Initial interventions typically include topical ultra or high-potency topical corticosteroids, which have been shown to reverse some histological changes, but do not typically improve scarring. Surgical interventions to address symptomatic scarring may restore vulvar anatomy and improve sexual function. Objective This study aims to evaluate the effects of surgical interventions, specifically lysis of vulvar adhesions and clitoral phimosis surgery, on sexual dysfunction, sexual distress, and overall patient satisfaction in women with VLS. Methods A prospective pre-post intervention cohort study was conducted on patients treated at three urban medical centers treating vulvar disorders from December 2003 to January 2025. Participants completed pre- and post-operative assessments including the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), and descriptive response questions regarding surgery. Statistical analysis was conducted with descriptive statistics (mean, median, standard deviation (SD)) and paired sample t-tests. Thematic analysis was conducted on patient narratives to capture qualitative outcomes. Results A total of 86 women (median age 52.0 ± 14.1 years) participated in the study, completing post-operative surveys. FSDS scores showed a substantial reduction from 30.24 (SD = 11.84) preoperatively to 16.61 (SD = 13.40) postoperatively (p 0.0001), with 82.4% (61/74) reporting improved sexual distress. The mean FSFI score improved significantly from 15.0 (SD = 7.87) preoperatively to 22.7 (SD = 8.35) postoperatively (p 0.0001), with 100% (71/71) of women reporting an overall improvement in sexual function. Patient satisfaction was 93.0% (80/86), with patients reporting being either “very satisfied” or “satisfied,” and 95.3% (82/86) indicating they would recommend the surgery to others. Only 7.0% (6/86) expressed dissatisfaction with surgical experience and outcomes. A qualitative analysis of patient responses revealed key themes, including improved sexual function, pain reduction, and psychological relief. Many patients reported restored sexual confidence and reduced distress, while a minority expressed frustration due to recurrent symptoms. Postoperative complications were reported by 14.0% (12/86), with the most common being recurrent scarring, which was reported in 33.7% (29/86). Revision surgery was performed in 10.5% (9/86) of cases, with all patients reporting improvement following revision. Conclusions Patients with VLS who undergo surgical management of vulvar adhesions report significant improvements in sexual function and distress, with high satisfaction rates. While a small subset of patients experienced complications or required revision surgeries, the overall positive outcomes support the procedure as an effective intervention for symptomatic scarring in the setting of VLS. These results emphasize the need for adequate preoperative counseling and patient selection to optimize long-term success and patient satisfaction. Disclosure No.