(105) CHALLENGES WITH DIAGNOSIS OF LABIAL AGGLUTINATION DUE TO LICHEN SCLEROSUS
Authors: Ghosalkar E , Epstein S , Epstein A , Pope R 
Published: June 2024

Abstract

Introduction
Fusion of the labia minora or majora – labial adhesion– lacks a clear etiology but is associated with factors like low estrogen levels and lichen sclerosus. 1 Thus, Genitourinary Syndrome of Menopause (GSM) is a frequent contributor due to low estrogen. 2 If symptoms persist after use of topical estrogen, surgical resection of adhesions is needed for urinary and sexual function. 3 Lichen sclerosus (LS) is a chronic inflammatory disease characterized by anogenital white plaques and pruritus. 4 Early diagnosis and treatment of LS can decrease the risk of development of labial adhesions. There is a lack of information on the etiology of labial agglutination; specifically whether it is from LS or GSM–or both. Although lichen sclerosus is a known etiology of labial adhesions, it is frequently not associated with the diagnosis. Additionally, there are no retrospective or prospective studies evaluating the rate of diagnosis of LS via biopsy in patients receiving surgery to correct their labial agglutination.

Objective
To investigate the prevalence of lichen sclerosus as a potential etiological factor for labial agglutination (LA) and evaluate the necessity for enhanced biopsy rates in LA patients to improve clinical management.

Methods
The TrinetX database was used to obtain medical data from 80 healthcare centers globally. The cohort studied was patients with LA, identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding. The cohort was stratified by those that underwent surgery on the vulva 2 years after diagnosis of LA to establish a causal relationship. Furthermore, a second cohort of patients with LA and a concomitant diagnosis of LS was identified. Each cohort underwent stratification by age and race.

Results
From TrinetX, 10,771 women over the age of 18 were diagnosed with LA from 2000 to 2023. Of those, 3288 (30.53%) underwent a surgical procedure on the female genital system (CPT Code: 1003143) within 2 years of a diagnosis. Surgeries based on CPT codes included: Surgical Procedures on the Vagina (1008716); Surgical Procedures on the Vulva Perineum, and Vagina (1008682); Excision Procedure on the Vulva, Perineum, and Vagina (1008692); Vulvectomy simply (1008696); and Incision Procedures on the Vulva, Perineum, and Vagina (1008683). Demographic data of women who underwent surgery included a mean age of 25 years and range of 72 years (18 to 90 years) with 69% identified as white, 7% as Black or African American, 19% unknown race, and 3% other race. Of the 3,288 total women, only 11% had a documented biopsy prior to or with the surgery, leading to 7.07% (762 women) being diagnosed with LS.

Conclusions
The data collected indicates that labial agglutination is a disorder with a complex etiology, yet does have an association with LS, emphasizing the need for biopsy to provide appropriate clinical management. This can also prove challenging with lack of medical coding, leading to inconsistent diagnosis and treatment of LA. Future studies further investigating the etiologies of labial agglutination and their prevalence would shape how female sexual healthcare disorders like labial agglutination are approached to provide better patient care.

Disclosure
No.