Labial Adhesions

Author: Kenneth G Nepple, MD; Chief Editor: Andrea L Zuckerman, MD more...

Updated: Jan 18, 2012

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Background
Pathophysiology
Epidemiology
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Background

Labial adhesions are a common disorder in prepubertal females. The disorder is usually asymptomatic and is often first noticed by parents or during a routine physical examination.^[1]A host of other pediatric vaginal or urethral disorders, including an imperforate hymen or a septate vagina, must be excluded. Treatment of labial adhesions is typically conservative.

See the image below.

Typical appearance of labial adhesions

Pathophysiology

Labial adhesions are fibrous adhesions between the labia majora. Labial adhesions are due to low estrogen levels in prepubertal girls and contact with irritants.

Frequency

United States

A prospective study of over 1900 girls assessed through a pediatric outpatient clinic reported a 1.8% incidence of labial adhesions, whereas a review of over 9000 female infants found no cases of neonatal labial adhesions.^[2]

International

Incidence of labial adhesions worldwide is unknown but presumably similar to US incidence.

Mortality/Morbidity

Labial adhesions are generally asymptomatic and not a common cause of urologic or gynecologic morbidity. Labial adhesions can rarely cause urinary outflow deflection or obstruction, leading to vaginal reflux of urine and subsequent vaginal leaking when the child stands after voiding.

Race

No strong evidence supports a racial predilection.

Sex

Labial adhesions are a female pediatric disorder.

Age

Labial adhesions occur most often in infants and girls aged 3 months to 6 years, with a peak incidence around the age of 13-23 months.^[2]Labial adhesions have not been reported in the newborn period. If left untreated, labial adhesions usually spontaneously resolve at puberty, likely as a result of increased estrogen levels.

Proceed to Clinical Presentation

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

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