Lichen Sclerosis Involving Vagina and Cervix

Abstract

Background: Lichen Sclerosus (LS) is commonly a disease of the vulva usually seen in postmenopausal women. It presents as an atrophic white patchy area in a figure of 8 pattern. Fissuring is also commonly seen because of skin fragility. It is diagnosed by history and clinical assessment but usually confirmed with a biopsy. There is no cure for LS. The mainstay of treatment is potent topical steroids and in some cases oral immunosuppressive medicines may also be used. It is important to acknowledge the role of laser surgery in treat ing the sequel of scarring secondary to LS. Because LS is associ ated with increased risk of squamous cell carcinoma in women with genital involvement, it is important for those affected to have lifelong screening examinations as well as continued treatment to keep the disorder under control. Only six cases of vaginal LS, but no cases of cervical LS exist in the literature. Case: The authors present a case of a postmenopausal lady pre senting with a 30 year history of prolapse and a urinary tract infec tion. Examination revealed, 3rd degree utero-vaginal prolapse with widespread whitish discoloration of anterior, posterior and lateral vaginal walls, which also included the cervix. After counseling the patient and presenting her with the options for treatment, she chose to have the gellhorn pessary inserted in the outpatient clinic. Vaginal and cervical biopsy was taken under local anesthesia and histology confirmed LS. Patient was followed up in clinic and prescribed ste -roids. Conclusion: LS involving the vagina and cervix is a rare occurrence, unlike lichen planus, which can present in the vagina. Long term untreated genital prolapse may have a role in the development. As the occurrence of this condition is rare, each case should be treated individually and ideally after discussion in MDT meeting.