Labial Adhesions

Case

The mother of a 7 month old girl comes to the office because she can not see the babies vagina when she changes the diaper. The baby is otherwise doing well and has frequent wet diapers. How would you treat this patient?

 

Epidemiology

Labial adhesions are common in females between the ages of 4 months and 6 years. It results from the presence of inflammation secondary to irritation in a low estrogen environment, thus it is not seen at birth and after puberty. There appears to be no opening and the urethra is not visualized. Often referred for "absent vagina" Rare incidence of urinary retention.

5% of prepubertal girls and up to 10 % of girls<12 months of age

 

Etiology

  1. Poor hygiene
  2. Enterobiasis vernicularis
  3. Candida infection
  4. Group A Streptococcus, sometimes associated with throat infection
  5. Symptomatic infections
    1. Gonococcal infections
    2. Trichomonas infections
    3. vaginalis
    4. Gardenella vaginalis

 

Management

  1. Examination should detect the labial agglutination and your exam should include looking for signs of infection, rash, discharge, and sexual abuse.
  2. If there are signs of a urinary tract infection, a sterile urine culture should be done.
  3. Emphasize good hygiene
    1. anterior to posterior wiping and cleaning
    2. changing diapers more frequently
    3. changing underwear daily
  4. Estrogen cream applied nightly for twice daily with finger over the fusion line.  Stop treatments if breast buds develop.  50-100 % success rate.
  5. Majority of cases will resolve without any therapy within 18 months. Therefore, reassurance is all that is necessary in most cases. If you manually break the adhesions, they will reform unless you put petroleum jelly on the edges.  This may also traumatize the patient.
  6. Reassurance--there is rarely a need to send to gynecologist for evaluation.

 

References

  1. Labial Adhesions. Pediatrics in Review March 1994
  2. McCann, John, Robert Wells, and Joan Voris. Genital findings in prepubertal girls selected for nonabuse: a descriptive study. Pediatrics 86.3 (1990): 428-439.
  3. Sugar, Naomi F., and Elinor A. Graham. Common gynecologic problems in prepubertal girls. Pediatrics in Review 27.6 (2006): 213-223.
  4. Bacon, Janice L. Prepubertal labial adhesions: evaluation of a referral population. American journal of obstetrics and gynecology 187.2 (2002): 327-332.
  5. Mayoglou, Lazarus, et al. Success of treatment modalities for labial fusion: a retrospective evaluation of topical and surgical treatments. Journal of pediatric and adolescent gynecology 22.4 (2009): 247-250.

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