1. L. Kathleen Posey, MD FACOG
In Office surgery and use of platelet rich plasma for treatment of vulvar lichen sclerosus to alleviate painful sexual intercourse
L. Kathleen Posey, MD FACOG
Charles Runels, MD

2. Research Objectives
To evaluate patients’ symptoms and signs of vulvar lichen sclerosus and the ability to have pain free sexual intercourse after in office surgery to remove adhesions, followed by injection with platelet-rich plasma (PRP).

3. Surgical Treatment
Surgical Lysis of Adhesions and Complicated Lichen Sclerosus
Complicated LS - adhesions and scarring causing functional limitation
Dyspareunia – pain during sexual intercourse, adhesions of posterior fourchette
Urinary dysfunction – results from disfigurement and stenosis of the introitus
Sexual dysfunction – decreased clitoral sensitivity
Rectal dysfunction – anal pain and tears with defecation
These complications are responsible for the highest morbidity in LS patients
Clitoral Phimosis Release - Surgery to lyse adhesions of the clitoral prepuce
Clitoral phimosis – surgical lysis of adhesions completely covering the clitoral prepuce that bury the glans clitoris creating the phimosis. Surgical lysis of the adhesions overlying the prepuce should resolve this complication of clitoral phimosis
Pseudocyst – buildup of smegma beneath fused prepuce that can be very painful and totally prevent glans stimulation (secondary anorgasmia)

4. Patients Study was Comprised of: Every Patient in the Study Had:
14 patients seen in a gynecology clinic between August 2014 & December 2016
All patients were diagnosed with Lichen sclerosus confirmed by biopsy.
Informed consent was obtained from all patients participating in this study
Every Patient in the Study Had:
Previously been treated with clobetasol with minimal improvement
Significant degree of adhesion formation over the clitoral prepuce with distortion and stenosis of the vaginal introitus along with distortion of the labia minora and adhesions of the posterior fourchette
Lichen sclerosus lesions severe enough to warrant surgical intervention
Complained of pain, bleeding, and tearing during sexual intercourse
All surgeries as well as PRP injections were preformed by me

5. Surgical Methods PRP Extraction from Whole Blood Anesthesia
Regens Lab Centrifuge – yields 10mL PRP from 20mL of a patient’s whole blood
Anesthesia
Topical Anesthetic cream BLT 20%/8%/8%– applied 20 mins prior to procedure
Lidocaine 2% Injection – 0.3cc into the dorsal nerve of the clitoris using a 30 gauge needle immediately prior to surgical dissection
Several patients were sedated with hydrocodone 7.5mg and diazepam 10mg
Surgical Dissection
Blunt Probe Dissection – Insert a 5mm cervical dilator to lyse adhesions and create pocket between the clitoris and the prepuce as well as a hemostat to release adhesions
Further Dissection - Iris scissors and blunt probe dissection of remaining adhesions involving the perineal body with a No. 15 blade scalpel
Sharp Knife Dissection – Insert hemostat into pocket, clamp and use to guide a 5mm horizontal incision of the dorsal prepuce using iris scissors
Hemostasis – Apply direct pressure and ferric subsulfate

6. Postoperative Methods
Postoperative site PRP injections
Bilateral injections into incised tissue – PRP injected into dissected areas of lichen sclerosus
DATA COLLECTION METHOD
Data collection - telephone administered 6-part questionnaire
Post-procedural timeframe – contacted 10 weeks after last intervention

7. results Would you recommend procedure? Percentage Patients
YES
100% 14 NO 0%
Overall satisfaction with outcome of procedure?
Very pleased with outcome
93% 13
Somewhat pleased by outcome
Not pleased by outcome 7% 1
Pain with sexual intercourse postoperatively?
Normal (no dyspareunia)
67% 6
Improved but not normal
33% 3
No partner
--- 5
Resolution of severe vulvar pruritus?
Complete symptom resolution?
50%  7
Improvement but not completely asymptomatic?
43%
No symptom improvement?
Bleeding with sexual intercourse post operatively?
Less bleeding
30%
Nn bleeding
70%
No Partner
Experienced complications?

8. Discussion & Conclusion
The primary conclusion that should be drawn from this study is that PRP contains endogenous factors that can improve the clinical and histological pathology by regeneration of healthy tissue at site of injury.
Utilizing available surgical techniques in conjunction with the regenerative effects of PRP has been shown to provide relief from dyspareunia in most patients that participated in this study. Similar findings can be found in studies of the efficacy of PRP as a treatment for LS.
Finally, as physicians, it is important to use our years of experience to recognize the importance of clinical experience not just statistical significance in patient care