Case # 21850

53 yo mother of two from Parker, Colorado referred to Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado by a friend who is a patient of the practice, for recent development of a clitoral abscess. She was seen by her gynecologist and completed a course of antibiotics prior to her appointment with Dr. Aguirre. During consultation she states she also has a long history of lichen sclerosus which was diagnoses 1 ½ years ago, but was symptomatic for many years. She had been on medication which she uses “when things flare up.” Dr. Aguirre performed a thorough pelvic examination with a chaperone present and patient observing with a handheld mirror. Examination is significant for end-stage lichen sclerosus changes with labial agglutination and loss of architecture and clitoral phimosis. There is no active abscess present. Lichen changes cover an hourglass shape around the vulva and anal area. Separation of the vulvar structures reveals a purse-string at the introitus, which is painful. All history and findings were discussed in detail with the patient along with her surgical and nonsurgical options. She preceded with Dr. Aguirre’s recommendation of in-office Clitoral Unhooding, with PRP (Platelet Rich Plasma) injections to the vulvar structures and introitus to help reduce the likelihood of another abscess formation and begin aggressive treatment of the vulva. Once healed, she began an aggressive course of Clobetasol to control the progression. She returned to the office for her regularly scheduled postop visits “very happy” with her results.