title: Complications after surgery for the relief of dyspareunia in women with lichen sclerosus: a case series.
abstract: BACKGROUND
  The objective of this study was to analyse complications after surgical intervention on the vulva, especially with grafting of the vaginal epithelium, for the relief of dyspareunia in women with lichen sclerosus.
  
  
  METHODS
  A case series of 23 women with histologically confirmed lichen sclerosus who underwent vulvar surgery because of disabling sexual dysfunction. Surgical care was provided in a university hospital (tertiary referral center) between 2008 and 2012. The interventions were posterior vestibuloplasty (perineoplasty), dehooding of the glans clitoridis and anterior vestibuloplasty with grafts of vaginal epithelium.
  
  
  RESULTS
  A posterior vestibuloplasty was performed in all 23 women. Short-term complications included postoperative infection with subtotal dehiscence of the advanced vaginal epithelium (n = 1), and reactivation of lichen sclerosus with the formation of bullae due to the postoperative discontinuation of dermatosteroid use (n = 1). The long-term complications included localized pain (n = 3); although the relation with the surgical intervention was unclear. Four women underwent dehooding of the glans clitoridis, all without complications. Anterior vestibuloplasty with a free full-thickness graft of vaginal mucosa was performed in five women. One woman underwent a second operation because of contraction and keratinization of the graft. The importance of estrogens for the condition of the graft was unclear.
  
  
  CONCLUSIONS
  After reconstructive vulvar surgery in women with lichen sclerosus, issues such as infection, reactivation of the disease and pain require attention. The use of vaginal grafts in the repair of the anterior vestibule is a novel approach and deserves further exploration.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Matthé P M
authors.identifier: http://orcid.org/0000-0002-3382-2268
authors.initials: MP
authors.lastname: Burger
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Miryam C
authors.identifier: http://orcid.org/0000-0001-9856-4012
authors.initials: MC
authors.lastname: Obdeijn
mesh_terms: D000328:Adult; D000368:Aged; D004414:Dyspareunia / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D014844:Vulva / Q000601:surgery*
keywords: Lichen sclerosus; complications; dyspareunia; fissures; grafting; plasty; vaginal grafts