*Corresponding author: Mohsen Hassan, Department of Obstetrics and Gy- naecology, King’s College Hospital NHS Foundation Trust, London, UK, Tel: +44 1689863000; E-mail: mohsensmh@hotmail.com Citation: Sayed K, Fernandes R, Hassan M (2019) Lichen Sclerosis Involving Vagina and Cervix. J Reprod Med Gynecol Obstet 4: 026. Received: July 30, 2019; Accepted: August 09, 2019; Published: August 16, 2019 Copyright: © 2019 Sayed K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Lichen Sclerosus (LS) is a chronic infammatory skin disease of unknown and poorly understood etiology. It was frst described by Hallopeau in 1887 as an atrophic form of lichen planus, although now it is believed to represent a separate disease entity [1]. Autoimmuni- ty likely has a role in the pathogenesis, possibly due to genetic, hor- monal, irritant and/or infectious factors (or a combination of these factors). Over the years, LS has gone by multiple names, including “circumscribed scleroderma,” “kraurosis vulvae,” “leukoplakic vulvi- tis,” “hypoplastic vulvar dystrophy,” “lichen sclerosus et atrophicus,” and (when seen in male patients) “balanitis xerotica obliterans” [2]. LS most commonly afects the anogenital skin and is seen more fre- quently among women than men. Lichen Sclerosis can afect all age groups with a higher incidence of onset during early childhood and afer menopause [1-3]. LS can be asymptomatic in some patients; however, in others, it can result in severe itching, burning, dyspareu- nia and irreversible anatomical changes with the potential to interfere with voiding and sexual function [4]. Case We report a case presenting as vaginal and cervical LS. Tere have been six cases of vaginal LS but no reported cases of cervical LS. Tis was case with a 30 year history of prolapse. Examination revealed, 3rd degree utero-vaginal prolapse with widespread whitish discoloration of anterior, posterior and lateral vaginal walls, which also included the cervix (Figures 1-5). Tere was no evidence of an underlying auto- immune condition or any signifcant medical/surgical history. Biopsy confrmed lichen sclerosis due to the evidence of stratifed squamous epithelium exhibiting hyperkeratosis, parakeratosis and irregular ac- anthosis along with an infltrate of lymphocytes, plasma cells and eo- sinophils in the sub-epithelium. Focally the sub-epithelium showed prominent hyalinisation of collagen. Patient chose to have a gellhorn pessary inserted to ease the symp- toms of the prolapse and was treated with topical steroids. She was followed up in the outpatient clinic after 3 to 4 months to assess the results of the topical steroids. She was also counseled about the surgi- cal management for her uetro-vaginal prolapse. The patient was given informed choice and was given time to consider the options. The ben- efts of surgical management would entail the following:- 1) Minimiz- ing the risk of changes in the vaginal/cervical mucosa to Squamous Sayed K, et al., J Reprod Med Gynecol Obstet 2019, 4: 026 DOI: 10.24966/RMGO-2574/100026 HSOA Journal of Reproductive Medicine, Gynaecology & Obstetrics Case Report Khashia Sayed, Ranzelle Fernandes and Mohsen Hassan* Department of Obstetrics and Gynaecology, King’s College Hospital NHS Foundation Trust, London, UK 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 fgure of 8 pattern. Fissuring is also commonly seen because of skin fragility. It is diagnosed by history and clinical assessment but usually confrmed 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 confrmed 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. Keywords: Genital prolapse; Lichen sclerosus; Steroids Figure 1: Complete prolapse of the uterus, protruding outside the introitus. The cervical OS can be seen clearly. Patchy white surface of mucosa must be observed.