Labial Adhesions Clinical Presentation

  • Author: Kenneth G Nepple, MD; Chief Editor: Andrea L Zuckerman, MD   more...
 
Updated: Jan 18, 2012
 

History

Labial adhesions are an asymptomatic disorder usually noted by parents or during routine examination. Some patients experience urine pooling in the vagina with voiding, and then experience subsequent urine leakage from the vagina when they stand after voiding (postvoid dribbling, also called vaginal voiding). Occasionally labial adhesions may also be noted in children with urinary tract infection. Children may note discomfort with voiding.

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Physical

The physical examination is aided by positioning the child in a frog-leg position and using a pull-down procedure where the labia majora are grasped and gently retracted caudally and laterally to better visualize the vagina. Labial adhesions are generally readily apparent as thin, pale, semi-translucent membranes cover the vaginal os between the labia minora. In severe cases, these adhesions entirely close the vaginal os. Typically the adhesions begin posteriorly and progress a variable distance anteriorly toward the clitoris. A careful examination should also evaluate for other interlabial masses or genital anomalies, such as fusion of the labia majora that can occur with intersex disorders. Signs of sexual abuse may include lacerations or hematoma.

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Causes

Low estrogen levels have been thought to play a causative role in the formation of labial adhesions, and the protective effect of maternal estrogen makes labial adhesions uncommon during the newborn period.[2] However, a more recent study found no statistically significant difference in serum estradiol levels between infants with labial adhesions and controls.[3] Labial adhesions may be caused by vaginal inflammation, local irritation, or tissue trauma. Labial adhesions have been reported as the result of childhood sexual abuse and may be associated with lacerations or hematoma.[4, 5]

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Contributor Information and Disclosures
Author

Kenneth G Nepple, MD  Physician, Department of Urology, University of Iowa Hospitals and Clinics

Kenneth G Nepple, MD is a member of the following medical societies: Alpha Omega Alpha and American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher S Cooper, MD, FACS, FAAP  Professor and Vice-Chairman of Urology, Director of Pediatric Urology, Children's Hospital of Iowa; Associate Dean for Student Affairs and Curriculum, University of Iowa, Roy J and Lucille A Carver College of Medicine

Christopher S Cooper, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, International Children's Continence Society, Phi Beta Kappa, Society for Basic Urologic Research, Society for Fetal Urology, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

Madhu Alagiri, MD  Director of Pediatric Urology, Associate Clinical Professor, Department of Surgery, University of California at San Diego

Madhu Alagiri, MD is a member of the following medical societies: American Academy of Pediatrics and American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Elizabeth Alderman, MD  Director of Fellowship Training Program, Director of Adolescent Ambulatory Service, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Merck Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD  Assistant Professor of Obstetrics/Gynecology and Pediatrics, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Nothing to disclose.

References

  1. Gaudens DA, Moh-Ello N, Fiogbe M, et al. [Labial fusion in the paediatric surgery department of Yopougon University hospital (Cote d'Ivoire): 108 cases]. Sante. Jan-Mar 2008;18(1):35-8. [Medline].

  2. Leung AK, Robson WL, Tay-Uyboco J. The incidence of labial fusion in children. J Paediatr Child Health. Jun 1993;29(3):235-6. [Medline].

  3. Caglar MK. Serum estradiol levels in infants with and without labial adhesions: the role of estrogen in the etiology and treatment. Pediatr Dermatol. Jul-Aug 2007;24(4):373-5. [Medline].

  4. McCann J, Voris J, Simon M. Labial adhesions and posterior fourchette injuries in childhood sexual abuse. Am J Dis Child. Jun 1988;142(6):659-63. [Medline].

  5. Muram D. Labial adhesions in sexually abused children. JAMA. Jan 15 1988;259(3):352-3. [Medline].

  6. Leung AK, Robson WL. Labial fusion and asymptomatic bacteriuria. Eur J Pediatr. Mar 1993;152(3):250-1. [Medline].

  7. Pokorny SF. Prepubertal vulvovaginopathies. Obstet Gynecol Clin North Am. Mar 1992;19(1):39-58. [Medline].

  8. Tebruegge M, Misra I, Nerminathan V. Is the topical application of oestrogen cream an effective intervention in girls suffering from labial adhesions?. Arch Dis Child. Mar 2007;92(3):268-71. [Medline].

  9. Myers JB, Sorensen CM, Wisner BP, Furness PD 3rd, Passamaneck M, Koyle MA. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol. Dec 2006;19(6):407-11. [Medline].

  10. Eroglu E, Yip M, Oktar T, Kayiran SM, Mocan H. How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: estrogen only, betamethasone only, and combination estrogen and betamethasone. J Pediatr Adolesc Gynecol. Dec 2011;24(6):389-91. [Medline].

  11. Soyer T. Topical estrogen therapy in labial adhesions in children: therapeutic or prophylactic?. J Pediatr Adolesc Gynecol. Aug 2007;20(4):241-4. [Medline].

  12. Schober J, Dulabon L, Martin-Alguacil N, Kow LM, Pfaff D. Significance of topical estrogens to labial fusion and vaginal introital integrity. J Pediatr Adolesc Gynecol. Oct 2006;19(5):337-9. [Medline].

  13. Baldwin DD, Landa HM. Common problems in pediatric gynecology. Urol Clin North Am. Feb 1995;22(1):161-76. [Medline].

  14. Hoebeke P, Depauw P, Van Laecke E, Oosterlinck W. The use of Emla cream as anaesthetic for minor urological surgery in children. Acta Urol Belg. Dec 1997;65(4):25-8. [Medline].

  15. Leung AK, Robson WL, Kao CP, Liu EK, Fong JH. Treatment of labial fusion with topical estrogen therapy. Clin Pediatr (Phila). Apr 2005;44(3):245-7. [Medline].

  16. Merguerian PA, McLorie, GA. Disorders of the female genitalia. In: Kelalis P, King L, Belman AB. Clinical Pediatric Urology. 3rd ed. Philadelphia: Elsevier; 1992.

  17. Nurzia MJ, Eickhorst KM, Ankem MK, Barone JG. The surgical treatment of labial adhesions in pre-pubertal girls. J Pediatr Adolesc Gynecol. Feb 2003;16(1):21-3. [Medline].

 
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Typical appearance of labial adhesions
 
 
 
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