It’s not a subject frequently talked about in parenting circles. Rest assured though, 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. A few simple tips will help you navigate this situation and help you avoid some common mistakes.
Usually, the lips of skin surrounding the entrance to the vagina are separate, with a clear opening in between. In some girls, the labia grow together and block the opening partially or even completely.
By far the most common form of vaginal obstruction in little girls is fusion of the labia minora because of labial adhesions. The biggest concern with labial adhesions is that they can predispose girls to repeated urinary tract infections.
Labial adhesions are typically diagnosed in girls from 6 months to 6 years of age.
Urine, stool, 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. When labial adhesions persist, the estrogen surge at puberty will correct the problem.
With treatment, the adhesions will disappear quickly, often within one week.
Adhesions are usually diagnosed based on the physical exam. Throughout their course, the adhesions should be followed by your pediatrician. If they do not respond to therapy, or if they were truly present at birth, further evaluation is indicated to look for other, far less common, abnormalities of the genitourinary system.
If there are no complications, such as infections or obstruction, the adhesions do not need to be treated.
Never attempt to separate the labia forcefully. This is painful and traumatic. Moreover, it usually results in even worse adhesions than before.
If treatment is needed or preferred, the natural process can be accelerated with the application of topical estrogen. A hormone cream such as Premarin should readily open the labia, usually within a week. Sometimes the cream needs to be applied for up to a month or two.
When the cream is stopped, the labia frequently re-fuse, because the tender labia can form new adhesions even more easily than before.
To prevent new adhesions, apply a lubricant such as KY 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, but if the fusion still recurs, repeat the hormone cream and continue applying the lubricant for one year.
Be sure to avoid 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 an estrogen cream, you should be aware that some girls will have other transient estrogen effects, including increased breast tissue and darkening 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. Most normal girl infants have some transient 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.
Preventing irritation to the labia will sometimes prevent adhesions. This means choosing diapers that are not irritating to your baby, changing them frequently, and treating diaper rashes quickly. Bubble baths and yeast diaper rashes are also common sources of irritation.
As girls get older, teach them to wipe from front to back.
If irritation begins to develop, applying a lubricant such as Vaseline or A & D ointment to the labia may prevent adhesions from forming.
Fused labia, Labial agglutination.