Patient Satisfaction of the Non-Surgical Lysis Procedure for Clitoral Adhesions in Patients with and without Lichen Sclerosuas
Authors: Nico E , Romanello J , Myers M , Sussman R , Marantidis J , Rubin R 
Published: July 2022

ABSTRACT

Introduction
Lichen sclerosus (LS) is a chronic, inflammatory skin disorder in the anogenital region typically found in prepubertal or postmenopausal women that causes skin thinning, whitening, wrinkling, itching, and pain. LS is an established risk factor for the development of clitoral adhesions (CA). CA occur when the prepuce adheres to the glans clitoris leading to discomfort, hypersensitivity/hyposensitivity, difficulty reaching orgasm, and chronic vulvodynia. However, CA can also occur in the absence of LS. Two lysis of CA treatment modalities exist - one surgical procedure and one non-surgical, office-based procedure that stretches the preputial tissue open. Previous studies explored LS patient satisfaction with surgical lysis or dorsal-slit surgery but not with the non-surgical approach. The non-surgical office-based procedure has also never been studied in patients without LS.

Objective
The aim of this study is two-fold: to evaluate patient satisfaction and outcomes of the non-surgical lysis of CA procedure in women with LS and to compare the efficacy of the procedure in patients with and without LS.

Methods
61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a retrospective chart review. An online survey was sent to these patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure.

Results
41 women participated in the study (67% response rate) and 5 had a diagnosis of LS that was optimally treated with high-potent steroids. In terms of procedure satisfaction, there was no significant difference in patient satisfaction (80% vs 83%) or the likelihood of recommending the procedure to a friend who also had CA (80% vs. 94%) among women with and without LS. In regards to improving sexual functioning, there was no significant difference in the procedure's ability to improve sexual arousal (80% vs. 60%), ability to orgasm (80% vs. 62%), and sexual satisfaction (60 vs. 72%) between women with and without LS. Finally, there was no significant difference in reporting the procedure was painful (40% vs. 25%) or the incidence of recurrence of adhesions (40% vs. 51%).

Conclusions
This study demonstrates high patient satisfaction and improvement in sexual functioning associated with the non-surgical lysis procedure for CA in women with and without LS. CA should not be considered as an adjunct side-effect of LS but as an independent pathology. Physicians should examine the clitoris in women with and without LS in order to determine if a patient has CA. Once diagnosed, the non-surgical lysis procedure has similar efficacy and patient satisfaction in women with and without LS and could be considered as a treatment option for improving sexual function in women.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals