 | ||
|
| |    Labial Adhesions by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Labial adhesion, also referred to as labial agglutination, occurs in children when the inner vaginal lips (labia minora) fuse to each other. It often gives the appearance that the opening of the vagina has closed off. It may be noticed incidentally by a parent or by a physician during a medical examination, or the child may complain of irritation or difficulty urinating. Because the fusion sometimes creates a little pouch in front of the vagina where urine can collect, some children experience dribbling when they stand up after urinating. Occasionally a child will get a bladder infection or will have difficulty passing urine due to the obstruction but most often labial adhesions are not significant enough to obstruct the flow of urine. What causes labial adhesion? Experts aren't completely sure why the lips fuse together. The most likely cause is that inflammation of the labia minora creates two raw surfaces at the edges of the lips, which eventually heal together in the middle, partly or fully covering the opening of the vagina. Many factors can lead to inflammation and irritation of the vaginal lips. Exposure to irritants like fabric softener residue, perfumed soaps, or bits of stool; or a prolonged exposure to damp (as in wet diapers) all can cause irritation of the area. The lack of estrogen (which is normal before puberty) probably plays a role in this process. When is treatment necessary? Labial adhesions are commonly found in young girls between the ages of three months and six years. While experts used to think medical or surgical treatment was necessary, recent research has shown that cases involving adherence that is not obstructing the flow of urine usually resolve on their own over a period of 6 to 18 months. However, even when treatment is used, the likelihood that the labial adhesions will recur is high. The best approach is to eliminate factors that lead to inflammation and then be patient. Active treatment may be most helpful if your child is getting bladder infections, is extremely bothered by dribbling after urination, or has difficulty passing urine. Methods of treatment When treatment is necessary, a small amount of estrogen cream, sold by prescription, can be gently rubbed onto the area of fusion twice a day. Using a cotton-tipped applicator can assist you as you also put a bit of pressure along the fusion line. This therapy should be combined with careful avoidance of irritants and a daily bath in plain water. The labia usually will separate by three to eight weeks. Parents should be aware that some girls, and even infants, will experience a small amount of breast development during treatment with topical estrogen cream because the hormone can be absorbed into the blood stream. If this happens, consult your practitioner. It may be reassuring to know that the breast tissue usually goes away once the estrogen treatment is stopped. If estrogen treatment is not fully successful by eight weeks, a topical anesthetic like xylocaine ointment or EMLA cream can be used in the office and the practitioner can gently tease apart the lips. Parents should be aware that some practitioners have been taught to manually separate the child's adhered vaginal lips in the office setting without pretreatment with estrogen or topical anesthesia. This should be avoided, since the raw edges inevitably re-adhere, and the procedure is quite painful. Vulvar care measures combined with estrogen treatment when indicated is usually all that is needed. However, there have been reports of rare cases in which the labia totally heal together, forming a "skin bridge" that requires surgery. Prevention of recurrence After the labia separate, daily bathing in a tub of plain water, avoiding irritants, and treating the area with petrolatum or ointment usually prevents recurrence. Good vulvar hygiene does not mean that you need to scrub the vaginal area. Rather, it means avoiding irritants and trying to expose the area to some air every day. For a list of common irritants to avoid and other good hygiene measures, see our article "Vulvar Care".
| |  | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| About Us |
Contact Us |
Our Partners Privacy Policy | Ethics | Advertising Policy | Terms of Service © Copyright 2004 The Dr. Spock Company. All Rights Reserved. THIS SITE DOES NOT PROVIDE MEDICAL ADVICE. The information drSpock.com
provides is for educational purposes only and is not a substitute for
professional medical advice. Always seek the advice of your health care
professional if you have a specific health concern. Mention or advertisement
of any product, service, or brand does not constitute endorsement, guarantee,
or recommendation by The Dr. Spock Company. Please read our full
Terms of Service. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
