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.