Lichen sclerosus is a benign, chronic dermatological condition of unknown etiology that primarily affects the genitalia. The mainstay of therapy is a topical high-potency corticosteroid. Although benign, it is progressive and, in advanced stage disease, can lead to severe functional impairment requiring surgical management. We present a case of advanced lichen sclerosus that resulted in complete labial fusion and obstructive urinary retention requiring surgical intervention. We also performed a review of the literature on similar lichen sclerosus cases. A 71-yearold patient was referred to gynecologic surgery from their urologist for evaluation of complete labial fusion with associated urinary retention. A vulvoperineoplasty was successfully performed. Postoperatively, she was started on estradiol cream daily to assist with initial wound healing. After 19 days, the vagina remained patent and was healing properly. Four months later, she was successfully titrated to twice weekly dosing of clobetasol without recurrence of symptoms. In addition to successful surgical intervention, this case illustrates the need for frequent follow-up and maintenance therapy to prevent relapse.