Challenges With Diagnosis of Labial Agglutination Due to Lichen Sclerosus

Labial adhesion (LA) lacks a clear etiology but is associated with low estrogen levels and lichen sclerosus (LS). Genitourinary Syndrome of Menopause is a contributor due to low estrogen, needing surgical resection if symptoms persist after topical estrogen use. Early diagnosis and treatment of LS can decrease the risk of development of LA. The objective is to investigate LS prevalence as an etiological factor and evaluate the necessity for enhanced biopsy rates in LA patients.

TrinetX provided data from 80 global health care centers, focusing on patients with LA using ICD-10-CM coding. The cohort was stratified based on vulva surgery 2 years post-LA diagnosis to establish a causal relationship.

A total of 11,875 women over the age of 18 were diagnosed with LA from 2000 to 2023. Of those, 3,673 (30.93%) underwent a surgical procedure on the female genital system within 2 years. Demographic data included a mean age of 45 years, 67.9% identified as White, 6.53% as Black/African American, 20.52% unknown, and 2.45% other races. Of the 3,673 total women, 11% had a documented biopsy prior to or with the surgery, leading to 11% (395 women) being diagnosed with LS. Limitations include inconsistent medical coding, uncertain causality between conditions, and potential data inconsistencies from the national database.

Labial adhesion has a complex etiology, yet is associated with LS, emphasizing the need for biopsy in management when the first-line estrogen cream approach fails. Future studies on LA etiologies can improve approaches to female sexual health care disorders, enhancing patient care.