What is the name of a genital condition where labia lose distinction and sometimes lead to ulcerations?

Lichen Sclerosus

The condition you are describing is lichen sclerosus (LS), a chronic inflammatory dermatosis that causes loss of labial architecture through scarring, fusion of the labia minora, and can lead to fissures and ulcerations. 1

Clinical Presentation

Lichen sclerosus is a scarring process that causes loss of the labia minora, sealing of the clitoral hood, and burying of the clitoris. 1 The disease presents with:

• Porcelain-white papules and plaques affecting the interlabial sulci, labia minora, clitoral hood, clitoris, perineal body and perineum 1
• Fragile, thinned and atrophic skin with a characteristic figure-eight pattern around the vulva and anus 1
• Fissures and tears that develop with time, leading to pain and potential ulceration 1
• Scarring that causes fusion of the labia minora and narrowing of the introitus 1
• Areas of ecchymosis (bruising) often accompanying the white plaques 1

Key Diagnostic Features

The loss of labial distinction occurs through progressive scarring:

• Fusion of the labia minora eliminates the normal anatomical boundaries between structures 1
• Obliteration of the labia minora can occur in advanced disease 2
• Stenosis of the introitus develops as scarring progresses 2
• Buried clitoris results from sealing of the clitoral hood 1

Ulceration Mechanism

Fissures and ulcerations develop because the involved skin becomes inelastic and prone to tearing. 1 The fragile, atrophic skin is susceptible to:

• Mechanical trauma during daily activities 1
• Erosions that cause pain 1
• Fissuring that can be severe enough to cause dyspareunia and pain with defecation 1

Epidemiology

Lichen sclerosus has a bimodal age distribution with peaks in prepubertal girls and postmenopausal women. 1 The disease:

• Affects the anogenital area in 85-98% of female patients 1
• Is more prevalent in women than men with ratios of 6:1 to 10:1 1
• Most commonly presents in postmenopausal women in the fifth to sixth decade of life 1

Important Clinical Pitfall

In prepubertal girls, the ecchymosis and fissuring of lichen sclerosus may be mistaken for signs of sexual abuse. 1 However, the diagnosis of lichen sclerosus does not exclude the possibility of concurrent abuse, as trauma may trigger disease onset through Koebnerization 1.

Associated Symptoms

Beyond the structural changes:

• Intractable pruritus is the main symptom, often worse at night 1
• Dyspareunia occurs with erosions, fissures, or introital narrowing 1
• Dysuria and pain on defecation from perianal involvement 1
• Some patients remain asymptomatic despite visible disease 1

Etiology

Lichen sclerosus is considered an autoimmune inflammatory dermatosis with evidence including:

• Increased incidence of tissue-specific antibodies 1
• Associations with other autoimmune diseases 1
• Positive associations with HLA class II antigens 1
• Presence of circulating extracellular matrix protein antibodies 1