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.
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.
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 differences [disorders] of sex development [DSDs]).
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Typical appearance of labial adhesions.
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Labial adhesions before lysis.
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Labial adhesions after lysis.
