Fused Vagina

My daughter has had a fused vagina since she was born. The pediatrician prescribed a topical hormonal medication which opens it up, but every time we stop medication it closes again. We have never heard of this happening to any other girls. The doctor says that by the time she reaches puberty, her own hormones will fix the problem. Should we be concerned?

Fused Vagina

Dr. Greene’s Answer:

By far the most common form of vaginal obstruction in little girls is fusion of the labia minora as a result of labial adhesions. These are typically diagnosed in girls from 6 months to 6 years of age. In fact, it is thought that somewhere between 1 and 10 % of little girls develop this condition! (Williams Gynecology 2008) Diaper rash, infections, irritants, or mechanical trauma commonly cause chronic inflammation of the labia. Occasionally the inflammation is the result of chronic sexual abuse. Whatever the cause, as the labia try to heal, fibrous tissue adheres the labia to each other. Some girls are prone to forming adhesions no matter how careful the parents are. The adhesions result in a smooth membrane over the vulvar opening with a thin, pale line at the center. This surface membrane usually starts forming at the rear of the opening, and ‘zippers’ closed toward the front. Usually, a sufficient opening at the front remains to permit urine and vaginal secretions to exit.

The adhesions will often resolve spontaneously when girls are out of diapers or pull-ups both day and night. Your doctor is right that when labial adhesions persist, the estrogen surge at puberty will correct the problem. If there are no complications, such as infections or obstruction, the adhesions do not need to be treated.

If treatment is needed, the natural process can be accelerated with the application of topical estrogen. If the problem is truly labial adhesions, this should readily open the labia.

As you have discovered, when the estrogen is stopped, the labia frequently re-fuse, since the tender labia can form new adhesions even more easily than before. To prevent this, apply a lubricant such as KY jelly, petroleum jelly, or A & D ointment to the labia every night for 2 -3 months. Most of the time this will be sufficient to break the cycle. Be sure to remove any irritants (such as bubble baths), treat any infections (such as yeast), heal any diaper rash, and teach good genital hygiene (wipe from front to back).

If you do use estrogen cream like Premarin, you should be aware that some girls will have other transient estrogen effects, including increased breast tissue and hyperpigmentation of the labia and/or nipples. These resolve when the estrogen applications stop. Stopping the estrogen also sometimes causes a brief ‘mini-period,’ or vaginal bleeding. The bleeding is self-limited, and not a cause for concern. Interestingly, most normal girl infants transiently have some degree of precisely these symptoms shortly after birth. Although it has never been studied, I suspect that those who later form labial adhesions don’t have these findings. Perhaps those prone to forming labial adhesions have mildly lower levels of estrogen than average.

Throughout their course, the adhesions should be followed by your pediatrician. If they do not respond to the therapy outlined above, or if they were truly present at birth, further evaluation is indicated to look for other, far less common, abnormalities of the genitourinary system.

Never attempt to separate the labia forcefully. This is painful and traumatic. Moreover it usually results in even worse adhesions than before.

In the office, I often see girls with labial adhesions. Almost none of the parents has heard of this condition. It’s not frequently talked about in parenting circles. Rest assured though, that labial adhesions are common, rarely uncomfortable, easily treatable, and will usually resolve even without treatment. Even though the condition looks worrisome, it need not be a cause for concern.

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Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Vicki Pertillar

    My 10 year child is still having this issue. We have tried this topical cream many times. It will open then close again. She has gained 20 pounds since the fisrt of the year and, now she is having problems with her vision.

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  2. disqus_gWWVjEOFqk

    jad my daughters dr tried that and now she is horrified of drs. BOTH my daughters had this problem and it didnt start at birth….unfortunately .after a huge story they were talking about together was over heard and many issues and horrible things found out later i figured out what likely was the reasoning behind this. my children never had diaper rashes were never left in wet or dirty diapers and my youngest daughter was potty trained before the age of 2 . my now 7 year olds has finally fixed and is normal now. she fell on or swing when she was 4 and she cried saying it hurt her there and after looking i saw it had broken open and i had her put vasaline on is day and night for about a month and it never closed again. my now almost 5 year old still has hers and i t looks much worse than my other daughters did and im now having her put vasaline on it daily in hopes it will get it to fix itself. im hoping it fixes on its own that cream burned them badly and they were horrified of having it again so i refused to ever have them put that on them again. i just hope my youngest finally gets to normal ive heard surgery is needed if it doesnt change after puberty hits and can you imagine how awful that would be

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  3. Ruth Costa

    You address the vagina fusion in little girls, can you tell me anything about it occurring in senior females.

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  4. T Pearce

    Very helpful article…thank you! I have a quick question. My 19 month old daughter has a fused labia and we just finished 4 weeks of applying the estrogen cream daily about two weeks ago. I noticed she now has tiny hairs on her vagina. She used to have tiny white fuzz, but these are like short, light brown hairs. Could this be a result of the estrogen cream? I’m really worried the cream is messing with her hormones. I would appreciate any feedback you can give. Thank you!

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  5. This topic is important to so many people. You’ve asked great follow-up questions. Dr. Greene would love to answer them all, but he can’t. To try to answer the questions that are most important to the most people, we’ve added a new feature — Ask Dr. Greene!

    If you have a question, just go to http://www.drgreene.com/askdrgreene/ and submit your question.

    Dr. Greene will answer one question a day and he’s going to let our readers decide which question they would most like to see answered determined by the number of votes each question receives. (That means, you have a better chance of getting your question answered if you invite your friends to vote.)

    Check it out — http://www.drgreene.com/askdrgreene/ — and let us know what you think.

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  6. hafsa

    pls upload a picture of estrogen vaginal cream for children. I have the same problem with my little 2.5 year old daughter

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  7. Honey Dew

    My three yesr old was diagnosed eiyj fused vsgina since last august. My husband and I sought medical help and was adviced to use premarin once daily. I have noticed that my daughter vagina now has a very small opening and am feeling relieved. However, we live in one of the remote islands in the caribbean and I would like to seek further medical treatment overseas. Can someone please recommend a good urologist or pedatrican? Thanks.

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  8. Julie

    Thank you for this informative and reassuring article. My 6 month old daughter recently developed this condition. I am quite sure she was not born with it, although she did not have a mini-period at birth. Our Paed prescribed Premarin, but we are reluctant to give her hormones at such a young age. I get migraines with aura so cannot take any hormones or HRT. Do you know of any long-term effects that conjugated oestrogens could have on her later in life? Should we be concerned that she may have low levels of oestrogen? And lastly, do you know why Premarin was discontinued in the UK ?

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  9. Amanda Hoffman

    Can Premarin cause hives/rash? My 3 year old is has developed a rash on legs and it now moved up to face.

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    • Alan Greene

      Yes, Amanda, it is possible for the cream to cause hives / rash / itching.

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  10. Michelle

    Our daughter is now 3, since birth she did not have a vaginal opening and seemed completely fused shut. Now it seems more as you’ve described closed towards the bottom with a small opening as if zipped up. I realize most bodies will take care of this on their own, but at what age should we as parents be concerned and look at the hormone or other medical routes?

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    • Alan Greene

      Michelle, as long as there are no urinary or infection problems, I typically don’t consider doing anything medical until the child has been out of diapers / pull-ups both day and night for about 3 months. Most of the time the ‘problem’ will go away on its own by then.

      Even then, this will usually resolve on its own by the puberty hormone surge, so there is no rush to do anything if the child is otherwise developing normally and everyone is comfortable.

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  11. casey bryant

    I have just taken my 12 month baby to the GP with an almost completely fused labia. She had never had nappy rash and after having two boys I guess I just hadn’t picked it up. She has been this way since birth. I have an appointment with her paediatrician next week but I feel so worried! :-(

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    • Alan Greene

      Casey, I’m glad you are having this checked out with her paediatrician, but I hope the article was at least a little reassuring in the meantime. As you read, this happens often in little girls – and the good news is that for the great majority of them it never causes a problem, and gets better on its own without treatment.

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  12. JAD, Some very gentle traction during diaper changes should be fine — and may even help — but the goal would be to try to trigger her body to dissolve the adhesion sooner, not to try to separate the adhesion yourself, which could lead to more adhesions.

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  13. JAD

    My pediatrician diagnosed my four month old with fused labia and advised that I gently pull the surrounding skin each time I change her diaper. Everything I’m reading says not to try to separate the adhesion. Was I given bad advice?

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