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.

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. A.Nettles

    My grand daughter is 5 now it’s been going on since she was a few months old ,I was curious if there is anything else besides the estrogen salve ,her Dr. Prescribes premarian

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  2. Marc

    Hello Dr. Greene,

    Our daughters labia is sealed except for a small opening. A pediatrician first suggested to us to open it a little after each bath by gently prying apart. Another pediatrician suggested estrogen cream but after he noticed that my insurance doesn’t cover it, he then prescribed a hydrocortisone cream. Is that safe or recommended, you didn’t mention hydrocortisone as a treatment. He said we’d be using it “off label”.

    Thanks.
    Marc

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    • Kait

      My doctor prescribed the same thing today. You should be greatful because hydracortisone should really be presecribed before estrogen cream since estrogen has side effects like breasts on the baby.

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  3. Casey Clify

    Dr. GREEN,

    My oldest daughter had this issue when she was 4 years of age. We took her to a specialist at Cardinal Glennon in St. Louis, Missouri.

    Although not one of our town doctors heard of this. When at Cardinal Glennon the doctor told its they have seen this over & over and it is usually blue eyed/blond hair.

    But, they discovered my daughter was constipated ( even though the majority of her stool look normal to me. The constipation blocks of the uriter and backs up …this caused many b urininary Tracy infections.

    If it closes completely, the urine backs up into the kidneys as it did my daughter. She has scar tissue to the day and has kidney issues with the scared kidney.

    We took all binding foods away from her and this is a difficult chore since other family members had to give up these same foods. Cheeses, apple sauce, bannanas, peanut butter and so on and we replaced her diet with high fiber foods.

    Doctor added to get diet, fresh apple, was told applesauce gardens because it has been cooked. A cup of popcorn every night and teaspoon of mineral oil nightly, etc…

    It bothers my precious granddaughter for us to held on our hips. Mom’s should know this that holding her this way could cause it to rip it open and you don’t want that.

    We applied the premerian cream twice a day, we did exercises they told us to do..(hold her feet with your hands and act as though she is riding a bike. She also stated on a prophylactic drug for 6 months.

    She would have a urinary infection monthly. Our town doctor was continually giving us a med that the infection was resistant to. That was a very terrible thing to find out for 6 months she is taking a drug that was only taking the edge off.

    In the days with the cream, the Labia fusion was completely open. It happened again add it was time too re-ENTER those foods slowly into her diet. We never had the issue again.

    It’s important for parents to understand their child could have great. Consistency, then one little hard stool..that one little hard stool can cause big issues.

    Now my daughter has a 15 month old going through the fusion. Yes, she is blond hair , blue eyed also. No infections yet. I just think after

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  4. Mercy

    my daughter who is 6 is also having fused labia and we did d opening when she was 4 and it fused back again and I haven’t heard of premarin crème before am not even sure if its in my country Nigeria don’t know what to do anymore will it open on its own at puberty even after surgery or should I go back for another surgical opening I will appreciate comments pls.

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  5. Jess R.

    To parents of little girls with condition : I myself had this issue when I was born after finding the right medication to work, It corrected the issue. Today I am a completely and fully functioning and heathly 32 yr. Old mother of 1 . I have no abnormalities, issues or problems as a result of having a fused vagina when I was a child

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  6. Dorothy

    My cousin had this, but her parents didn’t realize there was a problem, they thought it was just a birth defect and believed there was nothing more to do. As she got older and more doctors were available she was now able to have surgery to open it but by then she was at the age of 14-15. Once they opened it, her backed menstrual cycles were able to be released, because her menstrual cycle had been kept inside it destroyed her uterus and had to be removed. She is now 40 she can’t have children and just had surgery in order to reconstruct her vagina in order to have penetration during sex. My advice is to take your daughter to the doctor to prevent this and additional problems from happening.

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  7. prodip biswas

    My baby 11month her vagina hole closed I used estrogen but failed the open this

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  8. Jennifer

    My daughter is a month shy of being 7. We have been using the premerian cream since she was 6mo old when I brought it to her PCP’s attention. The cream is very pricy with my insurance and I have to use it about every 2-3mo and use A&D in between. Is there any way that Drs can test children’s estrogen levels to see if they are low and truly the root cause of this occuring? My fear is with the continued years of use of estrogen cream and a significant female area cancers that run in my family (to as young as 5) does this set the bar higher for my daughter? Her PCP now doesn’t even want to prescribe the cream because she has little breasts that are defined and hair growth in her vaginal area.

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  9. Amanda

    I just noticed my 5 year old daughter vagina fused shut her hole is size of number 2pencil lead should I take her to er

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    • I’m not a doctor, but I am a mom. I think you do need to take your daughter to see her pediatrician, but this is not a weekend ER visit issue. I think you can wait until Monday and get an appointment with her doctor.

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  10. bharti, surendra

    My daughter is now 2 years old. As i saw since birth her vagina was visible. now it is not. Only urethra is visible. I am very tensified. I consulted the gynecologist last month. She said that this problem is since birth and it may be seen after her menstrual cycle time come. What can i do.

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    • A.Nettles

      One lady already posted on here about a family member waiting for the child to be 13 or 14 and we’ll now she’s 40 can’t have kids had to have surgery to take her uterus taken out

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  11. Caitlyn

    My daughter is 9 months old next week. Tonight, whilst changing her, I noticed that she wasn’t open. That seemed odd considering I would remember if that was the case when she was born. Off to the internet! I am so thoroughly relieved to find that this is not uncommon and can be from a bad diaper rash (she had a nasty one before we switched to cloth diapers that took about 2 months to heal). She doesn’t seem to be exhibiting any of the other symptoms that would show cause for concern, but I’m still going to mention it to her doctor next week. With the stipulation that I’ve heard it can and does often resolve itself. Thank you for this information, you’ve eased a new, young mom’s heart.

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    • renuka

      same here

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  12. Angel Blood

    around 6 months old my daughter’s vagina closed and I wasn’t really sure if this was normal, since she is my only daughter but I wanted to see if I could open it before I started to panic, now she didn’t cry or looked like it bothered her after I did that but I did get it opened put cream on it and it never closed since…. about a month later my daughter got really sick and they needed to put a catheter in her and for some reason they could not find her “pee hole” after two doctors was looking at her they finally spotted it, and I’m not sure what they did since I was up by her face trying to calm her down. trying so hard not to cry because my daughter was so dehydrated she nearly died. I’m not sure what they did but it looked like they had to re-open her “pee hole” like that was closing. My daughter’s three and she’s just now getting the hang of being potty trained but now I notice something odd. When she pees her pee goes up over the toilet and the rest goes all over her upper legs. So remembering what I said before I wanted to make sure everything was fine and now I look at her and I cant see her pee hole and there is a white line coming from the top of her vagina and coming down stopping at the top of her clitorus and her clitorus looks like its also getting covered now I’m not sure what a three year olds vagina look likes and this time it bothered her like it was hurting her and I didn’t even do nothing I was just looking. I’m not sure what I should do or if it will just get better on its own…. I don’t want to put her in any pain if I don’t have to so please let me know if what would be best for her. My daughter is Autistic, ADHD, and has a server speech and language delay, and now she might be Anemic, and now her vagina could close……

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    • thinkingoutsidethebox

      It has been a few months since you posted. I hope you got everything figured out and she is doing better. I know it’s a very scary situation for the both of you to be going through. You are not alone in your struggles. Hugs from a mom who understands. ASD x 3.

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    • KayD

      Hello, my daughter is also autistic and she was born with adhesions. She is now almost 8 years old and they are just now starting to bother her and seal up NEAR her pee hole almost like a zipper. Now we are on premarin cream to prevent that from happening because you can’t allow it to cover her hole or she is going to have host of other issues as well. I was always told that once she reaches puberty and starts making her own estrogen it will open completely and on its own. Of course you wait until puberty to pee so if you consult the doctor I’m sure she will prescribe premarin. Also, the last thing I would suggest is to try to physically open it yourself because the last thing either one of you wants is to have to deal with closures caused by scabs and sores. Hope this helps.

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      • To be clear, I am assuming you are warning against ever ripping open the adhesions. I agree, this is not a good solution.

        Best,
        @MsGreene
        Co-founder and Executive Producer, DrGreene.com

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  13. Patricia

    Hello, My daughter was born with a fused Vagina. Her pediatrician prescribed premarin cream for her, we applied it as instructed and stopped when she told us everything looked fine. We have since moved and my daughter is rarely ill. She is now 10 and has started puberty. I took her to a family doctor because she has been cramping for 5 months and not started her cycle. The doctor did not check her even after I told the doctor of her condition at birth, she just said that her body is gearing up toward the point of her starting her cycle.

    Well this month from April to May (2weeks) cramping has varied from mild to very painful. My concern is that she may be closed again or something much worse, but the doctor would not listen. You see family history is that my mother got breast cancer which was aggravated/accelerated by premarin (taking it because of early hysterectomy). I only remember cramping one month and then started but was age of 13. I also had ovarian cysts as well as endometriosis. Should I seek a second opinion for my daughter?

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    • If you are not comfortable with the care you have received from your family doctor, you have two options 1) Discuss it with your family doctor and ask for a more thorough exam and / or tests 2) Get a second opinion. I suppose there is a third option, which is to wait and see if her daughter’s symptoms clear up or get worse. But you should never hesitate to question your doctor or seek a second opinion.

      As a mother, if you feel something deserves more attention, it deserves more attention. If you push your doctor or get a second opinion and in the end it turns out your family doctor was right, every one wins. In the end if it turns out your family doctor was wrong to wait and see when your daughter needed treatment, she wins. Either way, it’s good for her.

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      • A.Nettles

        Sorry, my grand daughter is only 5 years old and when she told me that she was hurting down there I looked ,only because it’s been going on since birth as a parent I wouldn’t care how old my child was if the Dr.didn’t check it out best believe that I will be doing the checking my self

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  14. Kristeen

    Hi. My daughter is 14 months and she was born with a fused vagina. I am extremely concerned. I was induced and they kept me on pitocin for 24 hours after giving birth and while I was breast feeding. I later found out that is not what they are supposed to do. I’m worried that has something to do with my daughter’s hormonal issues now. Has anyone else heard of that?

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  15. Diana

    Hi, when i took my one year old daughter to Dr check up, he informed that she has a closed vagina.
    he told me to try doing some massage to that area, but i am scared of doing so, and exposing her to massage pressure (even if it is not really big pressure).
    When i was searching online for any medications for this, I read about “Premarin Cream”, i am also scared of using it because of the side effects & I also read it is not good for kids.
    Please let me know what shall i do, and whether her body will solve this by its own when she grows up.
    i am really worried about my daughter.

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    • Tiffany

      Hi. I had this when I was a baby, and the cream worked for me with some side effects. But they weren’t serious.

      I started my period at age 12. I’m not sure if it was because of the cream, but they were very irregular.

      I wouldn’t suggest the “massaging”. I doubt that alone really does anything without the cream.

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  16. Jennifer

    My daughter is now 7 and was born with a fully closed vagina and we have tried the estrogen cream on and off since she was a few months old and it opened up but always reclosed after using.

    We have also been through several surgeries to have it open and also the Drs have literally ripped it open and have told me to do the same…. I cannot do that to my daughter or let anyone else do it again! She’s been through enough pain with this.

    I also put Vaseline on her almost daily and still doesn’t help! She has been out of diapers and pull-ups since she was 2. Is there anything else I can do for my daughter? I feel helpless and she is embarrassed by the fact that pee drips out in her underwear and she can’t change them as often at school like she can at home.

    What else can I do to help my daughter? I have another appointment scheduled for next month with her urologist but in fear that they will want to rip it open again.

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    • Lisette

      Have you tried pads?

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  17. atiya

    This article is very very useful. I was so worried as nurses in the hospital terrified me that if I don’t go for surgry there will be so much problems for my baby girl. Surgry of a 18 mnth baby — oh, it’s too painful. But as I read that there is no worry in the case of fused vagina, I’m much relaxd. Thanks again.

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  18. sudha

    I just noticed that my baby has no vaginal opening and she is now 11 months old. Is this thing common on babies? What should I do about this? Please help.

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  19. Lil' Mrs.Mafia

    I just started premarin tonight. My baby just turned 1 and has no opening in her vagina. She’s only 1 and shouldn’t have to go through this.

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  20. Maureen

    Whenever i sex with my boyfriend i almost get pain..and we discovered that i have lack labia minora..why do i lack?what are the treatment and what are effect of lacking it during giving birth am scared

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  21. 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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  22. 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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  23. 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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  24. 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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    • Guilt

      Yes. I noticed pubic hair growing on my daughter at four. I trusted my doctor but she let me down. No doctor should prescribe estrogen for adhesions unless the kid can’t pee. If she can pee do not use this cream! Now Ill always be worried about my daughter getting cancer in the future as cancer is the main side effect to women. I learned that too late and she already had it off and on for two years. I hope to God it doesn’t happen. My younger daughter has an adhesion too but I will never put premarin on her and she is doing just fine without it. No problem. Wish I would have known this with my first daughter. Don’t put so much trust in your doctors like I did! Thats a huge mistake! Do your research.

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  25. 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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  26. 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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  27. 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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  28. 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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  29. 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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  30. 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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  31. 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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  32. 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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  33. 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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