American journal of obstetrics and gynecology
October 7, 2026 · via Europe PMC
Vulvar Lichen Sclerosus as a Risk Factor for Birth-related Perineal Tear.
Andersen CH, Sloth RB, Schmidt Arenholt LT, Lundbye-Christensen S, Olesen AV, Bernardes LS
AI summary — for doctors, generated from the abstract only
Women with vulvar lichen sclerosus have a higher risk of second-degree tears and obstetric anal sphincter injury at vaginal birth.
What was studied
Danish regional record-based comparison of 277 births to women with vulvar lichen sclerosus and 533 births to unaffected controls (2019-2024), plus an analysis of factors linked to sphincter injury within the lichen sclerosus group.
Key findings
- After adjusting for parity, birth weight, head circumference and vacuum delivery, lichen sclerosus was associated with second-degree tears (RR 1.37, 95% CI 1.14-1.65).
- It was also associated with obstetric anal sphincter injury, though the figures are cut off in the abstract.
- Within the lichen sclerosus group, narrowing of the introitus and symptoms during pregnancy were linked to sphincter injury.
Clinical relevance
Obstetric teams caring for women with known lichen sclerosus should recognise higher perineal trauma risk and plan antenatal counselling and intrapartum care accordingly.
Who should care
Limitations
Retrospective record review with modest numbers, and the abstract is truncated so the sphincter injury estimate and some details are unavailable.
Identify and examine women with lichen sclerosus antenatally, discuss perineal tear risk, and give particular thought to those with introital narrowing or symptoms.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
Vulvar lichen sclerosus is a chronic inflammatory skin disease that predominantly affects the anogenital region. While typically observed in postmenopausal women, it may also occur in women of reproductive age. The condition is diagnosed in approximately 1.7% of women; however, the actual prevalence is likely underestimated due to underdiagnosis and underreporting. Despite well-documented effects on vulvar anatomy and tissue integrity, evidence regarding its impact during pregnancy and childbirth remains limited.
OBJECTIVE
To evaluate whether women diagnosed with vulvar lichen sclerosus have an increased risk of obstetric perineal tears during vaginal delivery compared with unaffected women. A secondary objective was to identify potential risk factors associated with obstetric anal sphincter injuries in women with vulvar lichen sclerosus.
STUDY DESIGN
Medical records of women diagnosed with vulvar lichen sclerosus who gave birth in the North Denmark Region between October 1, 2019 and September 30, 2024 were included. For each birth given by a woman with vulvar lichen sclerosus, the next two births occurring in the Region by women without the diagnosis were selected as controls. To investigate for associations with perineal tears, maternal and obstetric factors were described and compared between the two groups, while relative risk was estimated with corresponding confidence intervals (CI). To identify factors associated with obstetric anal sphincter injuries in the vulvar lichen sclerosus group, bivariate regression models were performed based on significant differences between mild perineal tears (not requiring suturing, first- and second-degree tears) and obstetric anal sphincter injury.
RESULTS
In total, 277 medical birth records of women with vulvar lichen sclerosus and 533 controls were included. In multivariable analysis adjusted for parity, birth weight, head circumference, and vacuum-assisted delivery, vulvar lichen sclerosus was associated with a significantly increased risk of second-degree tears (relative risk 1.37, 95% CI 1.14-1.65, p <.001) and obstetric anal sphincter injuries (relative risk 3.37, 95% CI 1.30-8.76, p = 0.01) when compared with controls. In the vulvar lichen sclerosus group, bivariate analysis revealed a significant association between obstetric anal sphincter injuries and nulliparity (relative risk 4.91, 95% CI 1.10-21.91, p = 0.04), vacuum-assisted delivery (relative risk 6.50, 95% CI 2.19-19.28, p <.001), narrowing of the vaginal introitus (relative risk 6.20, 95% CI 1.66-23.17, p = 0.007), symptoms during pregnancy (relative risk 3.98, 95% CI 1.35-11.75, p = 0.01), and duration of the second stage of labor (relative risk 1.01, 95% CI 1.00-1.02, p = 0.02).
CONCLUSIONS
Vulvar lichen sclerosus was significantly associated with an increased risk of second-degree tears and obstetric anal sphincter injury after adjustment for obstetric variables. In the vulvar lichen sclerosus group, narrowing of the vaginal introitus and symptoms during pregnancy were associated with an increased risk of obstetric anal sphincter injury.
DOI
10.1016/j.ajog.2026.10.004
PMID
42843581
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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