Labial adhesions are a relatively common condition in pre-pubertal girls in which the labia minora join together. The labia minora are the inner lips of skin surrounding the vaginal opening. Labial adhesions are usually benign but can cause some complications if they persist. It is most common from age 6 months to 6 years old.
Symptoms
- The labia minora from each side fuse together in the middle, covering over all or part of the vaginal opening.
Cause
Hygiene is thought to play a role in some cases; irritation from urine or stool may inflame the labia, making them more likely to adhere and form adhesions. Irritants such as soaps, bubble baths, or diaper rashes may inflame the skin as well. Many times it seems to occur even with excellent hygiene. It is also thought to occur from a relative lack of estrogen. It seems to be worse when the child is still in diapers or pull-ups. Some believe it to be more common in overweight infants, toddlers and children, which may be because the extra weight is altering the child's hormonal balance or maybe a mechanical issue, with the labia more difficult to clean in overweight children.
Clinical course
The adhesions usually start towards the back or rear and work their way towards the abdomen (front). Sometimes they remain minor and only partially fuse; in other cases, they fuse almost completely. Labial adhesions do not usually cause any problems; however, if they fuse completely, they can cause urine to pool behind them and cause irritation and sometimes urinary tract infections. Adhesions usually resolve by puberty, when estrogen levels increase. If adhesions remain during puberty, they can obstruct menstrual flow. It is also helpful to treat labial adhesions so that the doctor can be sure of the diagnosis and that the vaginal opening is normal; other conditions can sometimes look like labial adhesions. In some patients, the adhesions tend to recur once they are treated.
Treatment
- Sometimes if the adhesions are very minor, gentle traction can open them. Parents may try this at home after a bath. This should be done very gently, however, because opening the adhesions can be painful.
- Treatment is usually with estrogen cream. It can be applied once a day directly to the adhesions; sometimes twice a day treatment is required. The adhesions usually open in 1-2 weeks of treatment.
- A lubricant such as Vaseline or A&D Ointment should be applied to the labia once they are open for at least 2-3 months, until healing is complete. In cases of recurrent adhesions, estrogen cream may be repeated until the adhesions open and then lubricant may need to be used for up to a year or until the child is potty trained.
- Your child should be examined once the adhesions open to be sure the rest of her anatomy is normal and that there is no predisposing condition for the formation of adhesions.
- Avoid irritants such as bubble baths and strong soaps and keep the area clean. Be sure older girls are wiping from front to back.
- Estrogen cream sometimes causes mild estrogen effects such as breast swelling, vaginal discharge or slight vaginal bleeding (a “mini-period”). These are harmless and will resolve when the cream is stopped.
Prevention
- Be sure the area is kept clean and that stool and urine are removed promptly.
- Avoid strong soaps, bubble baths, and anything else that may irritate the area.
- Treat diaper rashes as soon as they start.
- If irritation is developing in the area, start using lubricant such as Vaseline or A & D Ointment before the adhesions can form.
- Be sure older girls are wiping from front to back.
