Labial adhesion, also called labial agglutination, is actually quite common in girls prior to puberty. The labia (majora) fuse together.
There are usually no symptoms and treatment is minimal, however it is important to ensure other disorders are not present. Other conditions that may need to be investigated is an imperforate hymen (a hymen that completely closes off the vaginal entrance) or a septate vagina (the vaginal septum, creating a ‘double vagina’).
The ages labial adhesions most commonly occur are between three months and three years, but can stay later, until puberty.
Signs and symptoms
- Urine may fill up the vagina because it’s trapped, and leak out over a period of time after urinating (called postvoid dribbling or vaginal voiding).
- A secondary urinary tract infection may occur.
- Uncomfortable when urinating.
- A thin, pale, somewhat translucent membrane may cover the vaginal opening inside the labia minora. This may sometimes completely close over the vaginal opening, starting from the bottom of the vaginal opening and working its way up towards the clitoris.
- Some masses may grow on the labia or other genital abnormalities might be present
- Signs of sexual abuse may be present.
Diagnosing labial adhesion
These adhesions are most often found by parents or at an examination, and are more often found if there is inflammation of the vulva (vulvovaginitis).
When a doctor diagnosis labial adhesion, there are a few things they must rule out in that process.
- Hymen skin tags
- Imperforate hymen (where the hymen completely block the vaginal entrance)
- Introital cysts (paraurethral or Gartner duct cysts)
- Ureterocele (a birth defect causing urine flow problems)
- Urethral polyp
- Urethral prolapse
- Vaginal atresia or Müllerian agenesis (MRKH syndrome)
- Vaginal rhabdomyosarcoma
If a patient has urinary symptoms, urine culture may be requested to check.
Resolution and treatments
The resolution of labial adhesions most often occurs during puberty, but can occur in a short time after the condition develops, for example a year later. Normal treatment is to leave them alone, then to use oestrogen cream, then to try surgery. Steroid creams are also sometimes prescribed.
Oestrogen cream (Premarin)
This is applied 2-3 times per day for a few weeks, until the labia start to come apart, where frequency is reduced, and emollient cream is begun. Studies show this treatment has a very good success rate of over 90 per cent. All minor side effects are eliminated after the treatment ends.
The surgery is uncomplicated and does not require stitches. The labia come apart quite easily, however it can be painful for the child, so local anaesthetic is recommended. Sometimes a general anaesthetic will be warranted. Children most often do best in the operating room for this procedure, however it is on an individual basis.
- Topical oestrogen cream may be prescribed, particularly if frequent UTIs are occurring.
- Manual or surgical separation may need to be considered if urinary problems are being encountered and unresolved, or if the adhesion is very fibrous.
- Avoid exposure to irritants like soaps, detergents, bubble baths, and laundry detergent (choose hypoallergenic).
- Regularly visit with a doctor, paediatric urologist or gynaecologist to keep an eye on the issues.
- If oestrogen or surgery are used, emollient cream must be applied several times a day to keep the labai from reattaching.
Note: Oestrogen cream may cause a temporary pigmentation change on the area applied, however this normally fades after treatment stops. Your child’s breasts may become tender or enlarge.
Why does the labia adhere?
These adhesions are fibrous and occur between the labia majora. Their occurrence in childhood is the period where girls don’t have any oestrogen, also making this rare in newborns (who still keep oestrogen from their mothers). Oestrogen levels, however, have been tested and there was no significant difference in oestradiol levels in girls with labial adhesions and those without.
These adhesions can also be triggered by inflammation, irritation, or vaginal or vulvar trauma. Sexual abuse can result in labial adhesions due to trauma to the tissues.