Lysis of Vulvar Adhesions and Sexual Function in Vulvar Lichen Sclerosus

OBJECTIVE: To evaluate the effects of surgical interventions, specifically surgical correction of introital stenosis and clitoral phimosis in a procedure called lysis of vulvar adhesions, on sexual function, sexual distress, and overall patient satisfaction in individuals with vulvar lichen sclerosus. METHODS: A pre–post intervention mixed-methods cohort study was conducted on patients at three urban medical centers treating vulvar disorders from December 2013 to January 2025. Participants completed preoperative and postoperative assessments, including the Female Sexual Function Index, Female Sexual Distress Scale, and descriptive response questions regarding surgical outcomes. Statistical analysis was conducted with descriptive statistics and paired-sample t tests. Thematic analysis was conducted on patient narratives to capture qualitative outcomes. RESULTS: A total of 86 patients (median age 48.2±14.0 years) participated in the study, completing both preoperative and postoperative surveys. Female Sexual Distress Scale scores decreased from 30.2±11.84 preoperatively to 16.6±13.40 postoperatively ( P <.001), with 82.4% (61 of 74) reporting improved (decreased) sexual distress. The mean Female Sexual Function Index score improved significantly from 15.0±7.87 preoperatively to 22.7±8.35 postoperatively ( P <.001), indicating improvement in sexual function. Patient satisfaction was 93.0% (80 of 86), and 95.3% of patients (82 of 86) indicated that they would recommend the surgery to others; 7.0% (6 of 86) expressed dissatisfaction with surgical experience or outcomes. A qualitative analysis of patient responses revealed key themes, including improved sexual function, pain reduction, and psychological relief. Although 33.7% of patients reported some degree of recurrent scarring, clinically meaningful recurrence requiring revision surgery occurred in only 10.5% of cases (9 of 86) within a mean of 3.9 years. Patients reported improvement after revisional surgery. CONCLUSION: Patients with vulvar lichen sclerosus who undergo surgical management of vulvar adhesions report significant improvements in sexual function and distress with high satisfaction rates. Although a small subset of patients required revision surgeries, the overall positive outcomes support the procedure as an effective intervention for symptomatic scarring in the setting of vulvar lichen sclerosus. These results emphasize the need for providing adequate preoperative counseling and setting realistic expectations of outcomes to optimize long-term success and patient satisfaction.