Labial Adhesions

Overview

What are labial adhesions?

Labial adhesions happen when the inner skin folds (lips) of the vulva (the area that includes the urethra and vagina) stick together, rather than staying separated. Labial adhesions are also called labial fusion.

How common are labial adhesions?

In most cases, labial adhesions affect infants and young girls. This is called primary labial adhesions. They develop at least partly because there is a low level of estrogen in females before puberty. It’s estimated that labial adhesions affect about 2% of female children before puberty (the time of sexual maturation).

The condition may also affect women who have just given birth and women who have gone through menopause. This type is called secondary labial adhesions. Adhesions aren’t as common among older women but they can happen.

Symptoms and Causes

What causes labial adhesions?

The actual cause of labial adhesions is not completely known, but could be related to low levels of estrogen. In babies and young toddlers, frequent skin irritations, like diaper rash, may cause the labia to stick together.

What are the symptoms of labial adhesions?

Labial adhesions might not cause any symptoms in infants or young girls. When symptoms do occur, they might include:

  • Feeling pain in the area of the vagina, especially when straddling an object (like riding a bike).
  • Having a hard time urinating, with urine coming out in dribbles.
  • Getting many urinary tract infections (UTIs).
  • Having discharge from the vagina.

Symptoms of labial adhesions in adults are much the same. Adult women might also have itching, or have pain or other difficulties during sex.

Diagnosis and Tests

How are labial adhesions diagnosed?

Adhesions are usually seen by caretakers or healthcare providers. The diagnosis is made by looking at the vulva, the name for the outside genital area of a female.

A labial adhesion may look like a thin white line or a bridge of tissue that covers the opening to the vagina and/or the urethra (the tube that lets urine out of the body).

Management and Treatment

How are labial adhesions treated in younger girls?

If there are no symptoms and no problems urinating, the healthcare provider might want to wait for the girl to reach puberty and start producing estrogen. The provider may also recommend treatments including:

Topical treatments

If the adhesions cover a large area, or are causing problems for your child, you might be told to apply cream containing estrogen for about a month. In some studies comparing the use of estrogen-containing creams or ointments to non-medicinal lotions, the estrogen creams worked much better.

It’s important to apply the cream in the right amounts. Side effects of treatment could include vaginal bleeding, breast growth and irritation. These things generally disappear when the cream is stopped.

If the estrogen cream works to separate the lips, you might be told to apply petroleum jelly or some other ointment for another period of time. Sometimes petroleum jelly alone is enough if applied with a little pressure. You should talk to your provider before doing this.

Another type of cream contains the steroid betamethasone 0.5%. Your healthcare provider might suggest this in addition to estrogen or in place of estrogen. Betamethasone use should be time-limited, so never use this product without a prescription for labial adhesions.

Manual or surgical separation

If creams don’t work, it’s usually because the adhesion is thick. In very few cases, separation by hand might be needed if the adhesions are causing problems, such as blocking urine or causing many infections. Only experienced healthcare providers should do a manual separation.

The procedure calls for local anesthesia and possibly sedation. Surgical separation generally is only needed if the girl can’t urinate or if other treatments do not work. Surgery is also suggested for the rare labial adhesion that occurs after a pregnancy.

All treatments for labial adhesions should be followed up with good hygiene practices, such as daily baths with non-irritating cleaners. It’s a good idea to use a bland lubricant like petroleum jelly for about six to 12 months after treatment.

How are labial adhesions treated in girls and women who have already been through puberty?

Labial adhesion treatment in women and girls who have been through puberty is similar to treatment in infants: use of estrogen-containing cream or lotion, other types of cream or ointment and, if necessary, surgery.

What kind of home treatment is available for labial adhesions?

You may be told to apply ointments or creams like petroleum jelly to the area with a gentle massage. Keeping the area clean is also important. You shouldn’t try to separate the skin folds yourself. That should only be done by a healthcare provider who has experience with the process.

Will labia adhesions go away on their own?

Adhesions will often go away on their own when a girl reaches puberty and starts producing estrogen.

Prevention

Can labial adhesions be prevented?

Since the cause isn’t fully understood, healthcare providers don’t know how to prevent labial adhesions. However, it’s a good idea to keep the area clean and to watch out for signs of irritation such as redness, rashes or pain.

Outlook / Prognosis

What is the outlook for females with labial adhesions?

The outlook is very good. The problem resolves itself in many girls no later than when they begin menstruating. Treatments, when needed, are effective.

There is the chance that labial adhesions will return. It’s best to keep the area clean and possibly to continue to apply ointments like petroleum jelly.

A note from Cleveland Clinic

Labial adhesions, also called labial fusion, happen most often in infants and toddlers, but can also happen in older women who have just given birth or have been through menopause. Low estrogen levels are believed to be a cause, as are skin irritations. Let your healthcare provider know if your child or you have problems with your urinary tract that are affecting the skin of the vulva.

Last reviewed by a Cleveland Clinic medical professional on 08/10/2021.

References

  • North American Society for Pediatric and Adolescent Gynecology. . Accessed 9/1/2021.Caring for Your Child with Labial Adhesions (https://www.naspag.org/assets/docs/labial_adhesions_2020.pdf)
  • Liu DR. Pediatric Urologic and Gynecologic Disorders. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016.
  • Velander MH, Mikkelsen DB, Bygum A. . Acta Derm Venereol. 2009;89(2):198-9. Accessed 9/1/2021.Labial agglutination in a prepubertal girl: effect of topical oestrogen (https://pubmed.ncbi.nlm.nih.gov/19326016/)
  • Seehusen DA, Earwood JS. . J Am Board Fam Med. 2007;20(4):408-10. Accessed 9/1/2021.Postpartum labial adhesions (https://pubmed.ncbi.nlm.nih.gov/17615422/)
  • National Health Service. . Accessed 9/1/2021.Labial fusion (http://www.nhs.uk/conditions/labial-fusion/Pages/Introduction.aspx)
  • Department of Health, State Government of Victoria. . Accessed 8/6/2021.of Health, State Government of Victoria, Australia. Labial adhesions. Accessed 9/1/2021.Labial adhesions (https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/labial-adhesions)
  • Singh P, Han HC. . Int Urogynecol J. 2019 Sep;30(9):1429-1432. doi: 10.1007/s00192-018-3821-1. Epub 2018 Nov 28. PMID: 30488271. Accessed 9/1/2021.Labial adhesions in postmenopausal women: presentation and management (https://pubmed.ncbi.nlm.nih.gov/30488271/)

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