Background: Anatomical variations of the vulvoperineal region are under-recognized in standard gynecological literature despite their potential impact on sexual function and quality of life. In clinical practice, we repeatedly observed a membranous epithelial structure spanning the posterior fourchette, associated with introital narrowing, dyspareunia, and fissuring, which, to our knowledge has not been previously described.

Objective: To provide a detailed anatomical description, propose standardized nomenclature, and introduce a morphological classification for a previously undescribed anatomical variant—the Vulvoperineal Pterygium (VPP).

Methods: A descriptive, multicentre observational study was conducted between April 2023 and December 2024 in three centers in Spain and Argentina. Women aged ≥16 years attending routine gynecological consultation were included. Standardized documentation of VPP morphology and symptoms was performed. In cases with clinical fibrosis, a complete resective biopsy was performed for histopathological analysis. We propose a surgical technique for outpatient resective biopsy. A literature search found no prior descriptions of VPP.

Results: Among 2,171 women (17–84 years), 201 presented with VPP (9.3%). Of these, 120 (59.7%) underwent complete resective biopsy. Symptoms included dyspareunia (61.7%) and recurrent fissuring (44.1%). Associated conditions were vulvovaginal atrophy (44%) and history of lichen sclerosus (29%). Histology revealed stratified squamous epithelium with irregular basement membrane, fibrosis, vascular changes, and chronic inflammatory infiltrates.

Conclusions: VPP represents a previously unrecognized anatomical variant that may contribute to mechanical dyspareunia and recurrent fourchette fissures. Its identification and classification may enhance diagnostic accuracy and guide management. Histopathological findings suggest a potential relationship with early lichen sclerosus, warranting further research.