Labial Adhesions Clinical Presentation

Updated: Aug 17, 2020
  • Author: Kenneth G Nepple, MD; Chief Editor: Andrea L Zuckerman, MD  more...
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Presentation

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, 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 Examination

The physical examination is aided by positioning the child in a frog-leg position (if the patient is younger than 18 months) or a dorsal lithotomy position (if he or she is older than 18 months) and using a pull-down procedure in which the labia majora are gently retracted caudally and laterally to permit better visualization of the vagina. Pulling too hard can cause pain to the child and may lead to difficult examinations in the future.

Generally, labial adhesions are readily apparent as thin, pale, semitranslucent membranes covering the vaginal opening between the labia minora (see the images below). In severe cases, these adhesions entirely close the vaginal introitus.

Typical appearance of labial adhesions. Typical appearance of labial adhesions.
Labial adhesions before lysis. Labial adhesions before lysis.

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 (eg, fusion of the labia majora, which can occur with disorders of sexual differentiation).

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