Just Home from VIN II/III Laser Ablation (PlasmaJet) Outpatient Surgery

Appreciate your post. I do hope you are well too.

Since that first day back, unfortunately, excruciating pain at nearly every bathroom visit became the norm. I had no idea this was a possibility, but apparently I may be one of the few for whom it is this severely painful. I also had no heads up about how long this could go on for (it's now been 3 weeks), and that I may not be able to attend to some activities, including my once weekly PT job. Fortunately, they've been very supportive, but I recently mentioned to a nurse on the surgical team that they needed to make patients aware of this possibility, even if it's a possible range of outcomes, durations, and such.

Being in my mid-60s I was concerned they assumed I do not work (though I have all my life until the past few years) but she said they leave it to the patient to advise the team that they work and ask whether that could be impacted. I strongly advised the responsibility should be on them to advise of the time that it could take to recover. Otherwise, I was given the (optimistic, supportive) impression by my referring GYN MD that this would be a quick "one and done", in so many words, and move on. Not at all.

Again, hope this may be of some help for others on this lichen sclerosus/VIN II/III journey. Also, I've tried nearly everything available - by prescription and OTC - and absolutely NOTHING has calmed the excruciating pain upon urination/attempted BM but good old Vaseline. Thank goodness for that! I will be trying an OTC product that that nurse thoughtfully recommended from another patient found calming - this patient just had radiation treatment this week for her condition: Cicaplast (by La Roche Posay). In just the past few days the excruciating pain at bathroom visits has become more often crazy itchiness that lingers at times throughout the day. I'm not complaining about that intense itchiness in comparison to the excruciating pain - which I just had - but it is something that one may not be able to tolerate for long if in public.

If I can offer other creams/ointments/sprays I've tried, I can reply also with those.

Am thankful the team I have is reachable, so far accountable, and compassionate. Wishing this for everyone. A new phase of my life. Optimistic, though!

Hi skippingLiz!

I can certainly share my experience, and then ask for more Qs, if you have any. As it was (I think I mentioned), I had no info on what to expect, short of what the person who posted in 2014 shared - and that really helped.

If what you are having is laser ablation surgery, that is what I had in early February (done with a "plasma jet" in my case - apparently safer for those using it (the physician/s) than the CO2 laser); in my case it was done with general anesthesia, determining the "deep twilight" anesthesia wouldn't ensure I wouldn't have any kind of reflexive reaction to the procedure.

I'm nearly healed (I think!) from it, but on this end of the healing, the itchiness is more present than the ~3 weeks of excruciating pain I had. That pain was "only" when using the bathroom; the itchiness has been more present, unfortunately mostly at or just before bed. It has interfered with my sleeping, and affected my sleep schedule, as I've been up a few nights for hours because I couldn't ignore the itchiness, and so I couldn't fall or stay asleep, until I'd been up for a while in the middle of the night. I pray this itching is temporary, as I'm not to use the Clobetasol propionate 0.05% (steroid cream) that I'd normally use several times a week pre-surgery. I'm told I can use it again when the area is completely healed.

Further, in 4 days I will have a biopsy of one particular area that evidenced some concern (out of the 4 biopsies taken pre-laser ablation). I understand this area of concern is about the size of a pencil eraser, so the 1-inch elliptical area should cover that for further microscopic analysis.

To kind of wrap it up for now, my gynecologic oncologist ("GO") (who has done the procedure) and I will meet 2 weeks after this latest biopsy, we will go over the results and make a plan from there on how to proceed.

As I have researched it (and my GO will confirm this when we next meet), I have seen there is at least a 70 - 75% recurrence rate of the - precancerous VIN II/III? or the possible vulvar cancer? (that I have not yet been diagnosed with). Again, check with your doctor on this; I will.

Unlike other posts I've seen, the laser does not ensure it (the lichen sclerosus, the VIN II/III) is completely gone, or that any symptoms are vanquished. Lichen sclerosus ("LS") is for life; it is never cured - yet. The Clobetasol manages it.

I had minimal issues with the LS - in terms of any discomfort - before this surgery/procedure. Although (somewhat understandably) the doctor won't pin down a typical recovery period, mine - currently at 5 weeks - is longer than others, with the caveat that everyone is different. I might have mentioned I'd been diagnosed about 40 years ago with lichen sclerosus, but didn't have any issues with it until about 10-15+ years ago, and that is when a cream (that was testosterone-based) was prescribed by my OBGYN. Since then, Clobetasol has been the standard - and the one I've used for many years now, more often at outbreaks of sloughing skin, then less often, if at all.

I hope this has helped. In conclusion, for now, I would not go with the assumption that the LS will be gone forever. But, again, everyone is different, but the LS never goes away. It just seems there is a spectrum of how individuals experience it.

Also, I understand that I will be having LS checks every 6 months - for at least 5 years - with my GO. I expect these checks will need to go on for the rest of my life, which could be anywhere up to 25-30 years from now - but, of course, who knows? 👩‍🦳 I can reply with all the medications I tried to ease the pain post-surgery, if helpful, but the only one that has worked to calm the pain after the bathroom, and after the itchiness, is the Vaseline. (But I will be trying some other creams for the itching soon too.)

Sincere best wishes, and hope this calms some concerns or Qs. Talk with your Dr. ASK Qs, and narrow down your Qs to get the kind of answers that help in your case.

Hi skippingLiz!

I can certainly share my experience, and then ask for more Qs, if you have any. As it was (I think I mentioned), I had no info on what to expect, short of what the person who posted in 2014 shared - and that really helped.

If what you are having is laser ablation surgery, that is what I had in early February (done with a "plasma jet" in my case - apparently safer for those using it (the physician/s) than the CO2 laser); in my case it was done with general anesthesia, determining the "deep twilight" anesthesia wouldn't ensure I wouldn't have any kind of reflexive reaction to the procedure.

I'm nearly healed (I think!) from it, but on this end of the healing, the itchiness is more present than the ~3 weeks of excruciating pain I had. That pain was "only" when using the bathroom; the itchiness has been more present, unfortunately mostly at or just before bed. It has interfered with my sleeping, and affected my sleep schedule, as I've been up a few nights for hours because I couldn't ignore the itchiness, and so I couldn't fall or stay asleep, until I'd been up for a while in the middle of the night. I pray this itching is temporary, as I'm not to use the Clobetasol propionate 0.05% (steroid cream) that I'd normally use several times a week pre-surgery. I'm told I can use it again when the area is completely healed.

Further, in 4 days I will have a biopsy of one particular area that evidenced some concern (out of the 4 biopsies taken pre-laser ablation). I understand this area of concern is about the size of a pencil eraser, so the 1-inch elliptical area should cover that for further microscopic analysis.

To kind of wrap it up for now, my gynecologic oncologist ("GO") (who has done the procedure) and I will meet 2 weeks after this latest biopsy, we will go over the results and make a plan from there on how to proceed.

As I have researched it (and my GO will confirm this when we next meet), I have seen there is at least a 70 - 75% recurrence rate of the - precancerous VIN II/III? or the possible vulvar cancer? (that I have not yet been diagnosed with). Again, check with your doctor on this; I will.

Unlike other posts I've seen, the laser does not ensure it (the lichen sclerosus, the VIN II/III) is completely gone, or that any symptoms are vanquished. Lichen sclerosus ("LS") is for life; it is never cured - yet. The Clobetasol manages it.

I had minimal issues with the LS - in terms of any discomfort - before this surgery/procedure. Although (somewhat understandably) the doctor won't pin down a typical recovery period, mine - currently at 5 weeks - is longer than others, with the caveat that everyone is different. I might have mentioned I'd been diagnosed about 40 years ago with lichen sclerosus, but didn't have any issues with it until about 10-15+ years ago, and that is when a cream (that was testosterone-based) was prescribed by my OBGYN. Since then, Clobetasol has been the standard - and the one I've used for many years now, more often at outbreaks of sloughing skin, then less often, if at all.

I hope this has helped. In conclusion, for now, I would not go with the assumption that the LS will be gone forever. But, again, everyone is different, but the LS never goes away. It just seems there is a spectrum of how individuals experience it.

Also, I understand that I will be having LS checks every 6 months - for at least 5 years - with my GO. I expect these checks will need to go on for the rest of my life, which could be anywhere up to 25-30 years from now - but, of course, who knows? 👩‍🦳 I can reply with all the medications I tried to ease the pain post-surgery, if helpful, but the only one that has worked to calm the pain after the bathroom, and after the itchiness, is the Vaseline. (But I will be trying some other creams for the itching soon too.)

Sincere best wishes, and hope this calms some concerns or Qs. Talk with your Dr. ASK Qs, and narrow down your Qs to get the kind of answers that help in your case.

Thank you so much. The itching Creams I've tried since I posted this have not helped (Benadryl cream = diphenhydramine) & oral diphenhydramine (Benadryl pills) have not helped or reduced the itchiness. In fact, the Creams have only added to the icky/sticky misery of trying to deal with this.

Next biopsy is tomorrow. I'll try to press for more specific solutions.

Best wishes!

Hi! Thanks so much for checking in...

I fell ill the morning of the biopsy, so I am rescheduled for the 2nd week of April...so the biopsy results may not be available until the 3rd week of April.

If it works for you, let's check in then!

How are you doing/feeling, with your procedure coming up? Do let me know as much as you'd like. Will be thinking of you.

Best wishes...has your Gyn stated it is Lichen sclerosus (LS)?

VIN = Vulvar Intrepithelial Neoplasia, a precancerous condition as I understand it in my situation.

Mine is due to "differentiated" (dVIN), due to the skin condition LS.

And, the laser ablation is used to remove the precancerous layer which, I'm told, can progress from the top layer down/in (as opposed to progressing from lower epithelial layers - which it doesn't).

But, need this additional biopsy & need to keep checking on it & will make a plan with my Gyn Oncologist going forward.

Take care & ask Qs of this Dr., ask if it's LS, if not, what is it?, how to keep a check on it, what must be done to remove/control it?, what are the chances of recurrence?, in what period of time can this reoccur?

Read about it yourself in academic/ scientific publications, etc.

Let me know. Take good care of yourself by asking lots of important Qs.