General Medical Information

Labial Adhesions

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Agglutination of the labia is a common condition in prepubertal girls. Severe cases of agglutination may be confused with an imperforate hymen or ambiguous genitalia. Agglutination is an acquired condition. A fine line of demarcation between the clitoral hood (prepuce) and the labia minora that runs to the midline under the clitoris is always present. In ambiguous genitalia, a normal urethral meatus is identifiable on the floor of the vestibule just anterior to the imperforate hymen. Ambiguous genitalia is discussed in Chapter 5 and Chapter 6.

The etiology of labial adhesions is unknown but appears to be the result of a combination of vulvitis and the hypoestrogenic state of the prepubertal girl. Most children with agglutination of the labia are asymptomatic and require no treatment. Over 80% of cases of agglutination resolve spontaneously within 1 year. Most patients present between 2 months and 2 years of age, with 90% of cases presenting before age 6 years. Partial adhesions are common.

Patients presenting with urinary tract symptoms such as obstruction or urinary tract infections require therapy. Treatment should be offered if there is marked parental anxiety. Usually parents require considerable reassurance. The treatment of choice is topical estrogen cream applied at bedtime. It is effective in 90% of cases in 2 to 8 weeks. Separation may be maintained by application of a bland emollient twice a day for 1 to 2 months. Recurrences may be treated in the same way. Conditions responsible for irritation or vulvitis should be addressed. Thin adhesions could be teased apart using a moistened swab after application of lidocaine gel. Mechanical rupture of the adhesions by applying traction to the labia with the thumbs is not recommended. The resulting raw surfaces may cause reagglutination. Surgery rarely is necessary.

Adhesions may develop between the glans of the clitoris and the prepuce. Patients usually present with this condition until the age of 7 or 8 years. Patients are asymptomatic unless smegma accumulates under the prepuce or inflammation occurs. Spontaneous separation is common and will occur at the time of menarche; therefore, treatment is seldom necessary. When chronic inflammation is a problem, application of estrogen cream at bedtime for several weeks induces separation of the adhesions.