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  • Friday, June 17, 2016
  • 0706-000740 Poster 194 - LICHEN SCLEROSUS OF THE VULVA AFTER MALE TO FEMALE “PENILE INVERSION” VAGINOPLASTY

    June 20, 2016 8:00 AM - June 20, 2016 6:00 PM

    • Vladimir Kojovic, MD ;
    • Marta Bizic, MD, PhD ;
    • Borko Stojanovic, MD ;
    • Marko Majstorovic, MD ;
    • Svetlana Vujovic, MD, PhD ;
    • Dragana Duisin, MD, PhD ;
    • Dusica Zigic Markovic, MD, PhD ;
    • Miroslav Djordjevic, MD, PhD

    Purpose

    Lichen sclerosus is a chronic cutaneous disorder with predilection for genital skin. In women, lichen sclerosus presents as vulvar discomfort, pruritus, bruising, bleeding, discharge, dysuria, or painful defecation. Diagnosis and treatment of lichen sclerosus is of utmost importance in the prevention of complications such as scarring, adhesions, atrophy, or long-term sexual dysfunction. We present transwomen who developed vulvar lichen sclerosus following penile skin inversion vaginoplasty.

    Materials and Methods

    From September 2011 to July 2015, five patients were treated for vulvar lichen sclerosus developed after 11 to 37 months (median 29 months) following male to female gender reassignment surgery. The age at diagnosis ranged 28 to 57 years (median 48 years). There was no data about presence of the disease at the time of sex reassignment surgery. The main symptoms were dry and itchy skin of the vulvar region, labial adhesions, painful sexual intercourse with consequential bleeding and problems during voiding. Use of topical corticosteroids resulted in limited improvement in the early period, but it was not effective as a curative treatment of the disease. Surgery included excision of affected skin and new vulvoplasty. Buccal mucosa grafts and urethral flaps were used for the prevention of new skin adhesions and vulvar closure. 

    Results

    Biopsy specimens confirmed lichen sclerosis in all patients. In follow-up period (6 to 50 months) good esthetical and functional result was achieved in all patients. They were advised to apply periodical dilation of the vaginal introitus and topical corticosteroid treatment. 

    Conclusion

    Unrecognized or untreated vulvar lichen sclerosus in transwomen could result in severe voiding and sexual dysfunction. However, this is highly curable condition with adequate surgical treatment. Long-term follow-up and proper counseling of these patients is recommended to prevent recurrence of the disease.  




    Category: Surgery