Labial Adhesions

Labial adhesions occur when the labia minora adhere together forming a shiny membrane of inflammatory tissue. Labial adhesions range in severity from near complete fusion to milder cases with 30-50 percent of the length of the labia minora fused.

The reasons why labial adhesions occur are not known, but we do believe that estrogen may play a role. Adhesions are generally seen in girls between the ages of 3 months to 6 years when estrogen levels are low. Once girls begin puberty and estrogen levels increase, the adhesions are less common or may separate on their own.

A chronic inflammatory process as the result of fecal soiling, vulvovaginitis, eczema or dermatitis can also play a role in the development of the adhesion.

Labial adhesions often have no symptoms and are uncovered during a routine physical exam. Older girls may report urinary dribbling. This is a result of urine that gets trapped behind the adhesion, later dribbling out. Additionally, some girls may report irritation due to the adhesion. In other cases, girls may have frequent urinary tract infections as a result of the adhesions.

Since many girls have no symptoms, no treatment may be necessary. Adhesions will resolve on their own during puberty as the estrogen levels increase.

Lysing (breaking down) the adhesions is necessary if the adhesions are causing symptoms. Different options are available and the decision as to which approach to take will depend on your child's condition and her healthcare provider.

• One option is to simply apply Vaseline® with pressure to the adhesions. Over time, the pressure and the Vaseline® may be enough to separate the adhesion. Estrogen cream (premarin cream) can also be applied. During several weeks of using the cream, the adhesions should soften and begin to separate. While your child is using the estrogen cream, it is important to watch for known side effects (development of pubic hair, breast budding, general irritation). Once the cream is stopped, the side effects may go away.
• Manually breaking down the adhesions in the office, after applying a topical anesthetic cream, may be another approach for your child. If your provider recommends, this can also take place under a short general anesthesia in the operating room if the adhesions are very thick. In either situation, it will be important to apply Vaseline® to either side of the labia so it does not reattach as it heals.

Reviewed by: Division of Urology
Date: May 2011