Patient Background
We present a 62-year-old lady with a seven-year history of severe
erosive lichen planus. She first presented with vulvar itching but was
found to have oral manifestations as well. A diagnosis of orogenital
lichen planus was then confirmed on vulvar and buccal biopsies. The
vaginal disease progressed to labial agglutination and vaginal scarring
despite topical clobetasol propionate 0.05% ointment, topical
tacrolimus, oral hydroxychloroquine, topical oestrogen and high dose
prednisolone. Over a period of four years, her introital opening
narrowed to a diameter of 1cm due to worsening scarring and surgical
division was performed. While she continued medical treatment, she did
not comply with post-operative vaginal dilator usage. Labial fusion was
noted to recur within six months and by 18 months post-operative, the
vagina was obliterated to a 2mm with burying of the urethra opening
despite escalation to systemic mycophenolate [Figure 1].
Pre-operative magnetic resonance imaging revealed an obliterated lower
third of the vagina with accumulated cervico-vaginal fluid. Vulvoscopy
did not demonstrate any high-grade lesions. The patient now complained
of voiding difficulties with a poor stream and related hygiene issues.
She consented for an examination under anaesthesia and a vaginoplasty
with goal towards dividing vaginal adhesions and restoring her vaginal
anatomy.