Labial Adhesions

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Chapter 76 Labial Adhesions

INTRODUCTION

Description: Labial adhesions are agglutination of the labial folds resulting in fusion in the midline.

Prevalence: One percent to 2% of female children.

Predominant Age: Peak 2 to 6 years; may be found at any age up to puberty. May also occur in postmenopausal women with significant vulvar atrophy.

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Local inflammation and the hypoestrogenic environment of preadolescence.

Risk Factors: Labial infections or irritation.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Fusion of the labia majora in the midline (extends from just below the clitoris to the posterior fourchette)

• Retention of urine in the vestibule or vagina resulting in irritation, discharge, and odor

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation, reassurance, perineal hygiene, and sitz baths.

Specific Measures: Topical estrogen cream, gentle traction to separate the labia (only after estrogen pretreatment; generally not necessary and strongly discouraged). Surgical treatment is almost never required.

Diet: No specific dietary changes indicated.

Activity: No restriction.

Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP041 (Growing Up [Especially for Teens]).

Drug(s) of Choice

Topical estrogen cream (Premarin vaginal cream, Dienestrol cream)—small portion applied to the vulva twice a day for 7 to 10 days. May be continued one to three times a week if desired, although generally not necessary.

Contraindications: Undiagnosed vaginal bleeding.

FOLLOW-UP

Patient Monitoring: Normal health maintenance.

Prevention/Avoidance: Good perineal hygiene.

Possible Complications: Vaginitis, urinary tract infection, urinary retention, or vaginal cyst formation.

Expected Outcome: Excellent.

MISCELLANEOUS

ICD-9-CM Codes: 624.9.

Aribarg A. Topical oestrogen therapy for labial adhesions in children. Br J Obstet Gynaecol. 1975;82:424.

Bacon JL. Prepubertal labial adhesions: evaluation of a referral population. Am J Obstet Gynecol. 2002;187:327.

Johnson N, Lilford RJ, Sharpe D. A new surgical technique to treat refractory labial fusion in the elderly. Am J Obstet Gynecol. 1989;161:289.

Stovall TG, Murman D. Urinary retention secondary to labial adhesions. Adolesc Pediatr Gynecol. 1988;1:203.

Yano K, Hosokawa K, Takagi S, et al. Y-V advancement flaps for labial adhesions in postmenopausal women. Plast Reconstr Surg. 2002;109:2614.

Davis AJ, Katz VL. Pediatric and adolescent gynecology. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:263.

Muram D. Labial adhesions in sexually abused children. JAMA. 1988;259:352.

Smith RP. Gynecology in primary care. Baltimore: Williams & Wilkins, 1997;177.

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