episiotomy vs c/s for lichen
I have taken care of patient with lichen sclerosus and find that this condition can be perplexing to manage. When trying to decide between vaginal birth or c/s the issue that is of concern for the woman is not what is the most natural for mother and baby, it is how will the recovery go after delivery. I think that we can all agree that a nice, easy vaginal birth is wonderful. Lichen is a condition where the skin can tear with nothing more than gentle touch or mild pulling. Vaginal delivery, no matter how easy, is never a gentle touch or mild pulling. All of the stretching exercises that work for most women to prepare the perineum will not work with lichen. This is a BIG difference. The patient WILL tear with delivery and it is not so much how much or in what direction but how will it heal afterwards with all of the inflammatory response from the cut or tear. Here is where we do not have enough data out there to guide us in the decision making process. There is no one right answer that fits all comers. It truly is a difficult decision. Clearly a c/s will avoid any issues relating to healing with lichen sclerosus, as steroids would not be a good choice to place over an episiotomy or natural wound as they delay wound recovery and that is the treatment of choice for lichen. Good luck in your choice. In my practice, I discuss all of these issues at great length with my pregnant moms who have lichen in the vulvar area (or other vulvar conditions for that matter) and then they make the decision. When they cannot decide, then I usually recommend a c/s only because with that mode of delivery there is no guess work about how the recovery will go and will there be any aggravation to the area that is already so fragile.
Good Luck