Vulvar Widening Through Perineal Flap Transposition, Rigottomy, And Fat Grafting For Vulvar Lichen Sclerosus

OBJECTIVES: Vulvar lichen sclerosus (VLS) is a chronic condition. If untreated, it may lead to anatomical modifications, including introital stenosis, which may impact sexual function and quality of life. First line treatment with topical corticosteroids is not effective in a variable percentage of patients. This study aims to assess the effectiveness of a surgical procedure that combines vulvar widening through perineal flap transposition, rigottomy, and fat grafting for VLS-related introital stenosis. METHODS: A retrospective study included 35 women aged 18-85 with VLS-related introital stenosis who underwent the combined surgical procedure between 2010 and 2019. The surgical technique involved vulvar widening through vulvar flaps, rigottomy, and fat grafting. At the time of followup, which occurred in 2021, we evaluated: patient satisfaction, symptom severity, sexual function, quality of life, psychological well-being, vulvar architecture, and frequency of on-demand topical corticosteroids usage. RESULTS: 88.5% of patients were satisfied with the procedure. Significant improvements were observed in symptoms (p<0.05), psychological wellbeing (p<0.05), and quality of life (p<0.05) 6 and 12 months postsurgery. Sexual function also improved, although not significantly for all items of the questionnaire. Vulvar architecture was improved in 60% of cases. The need for topical corticosteroids was significantly reduced (p<0.002), with 85.7% of patients reporting no or on-demand usage. CONCLUSION: This approach offers a promising solution for severe VLS-related vulvar stenosis. Despite the retrospective nature of the study and its sample size, the long-term follow-up (up to eleven years) adds strength to the findings.