Fairchild and Haefner and Stalburg and Haefner bring to focus the disfiguring vulvovaginal effects of lichen planus and a protocol for the surgical management and postoperative care of severe vulvovaginal agglutination.

Based on my experience in using this technique, I would like to point out that surgical lysis of adhesions and the sizing and placement of a firm vaginal stent may place patients who have had a hysterectomy at higher risk of vaginal dehiscence intraoperatively because of the relative avascularity of the vaginal cuff. Traditional risk factors for posthysterectomy cuff dehiscence include postmenopausal status, corticosteroid use, penetrative vaginal trauma, and a history of vaginal surgery. Thus, the patient is also at risk from the postoperative protocol, which includes several of these factors. Patients should be counseled regarding the potential for vaginal dehiscence.

In the event of a vaginal dehiscence, their technique and protocol can be modified sensibly without sacrificing anatomic success by using a soft vaginal pack (for 4 days) instead of a firmer mold, decreasing the intravaginal steroid regimen to account for the injury (200 mg every bedtime for 2 weeks and then resume the taper, as described), and starting the dilator once the pack is removed with caution to the patient to not exceed the newly established vaginal length.