Adhesions of Labia Minora (Synechia Vulvae) in Childhood

Abstract

Summary The diagnostic and therapeutic problems in 14 cases of adhesions of the labia minora in children are mentioned. It was found that the condition is quite frequent, is acquired and occurs predominantly during the first 2 years of life. Thorough investigation of the external genitalia in little girls is essential to establish the diagnosis. This is important because the treatment, in which the adhesions are ruptured by means of slight lateral traction, is very easy and painless and because the untreated condition may result in urinary symptoms. Follow‐up treatment with an indifferent ointment applied to the exposed epithelial surfaces is important in order to avoid recurrence. Recognition of the condition is important as incorrect interpretation as pseudohermaphroditism may cause much anxiety and trouble for the children and their families. The pathogenesis is unknown and the hypothesis that it is due to an exaggerated form of the normal childhood hypoestrogenism in the affected children deserves further investigation.

Manual separation followed by local cleanliness for pediatric labial adhesion

“…6 In one report 7 recurrence was ascribed to a lack of local cleanliness after separation, while another report 6 did not touch on local cleanliness. In contrast to these reports, 6,7 no recurrence occurred in the present cases. Local inflammation is considered to be responsible for labial adhesion.…”

Labial fusion and asymptomatic bacteriuria

“…Labial fusion per se is usually asymptomatic and is regarded by some authors as benign and self-limiting [1,4,6]. The present study demonstrates that labial fusion may be associated with asymptomatic bacteriuria.…”

Urinary incontinence secondary to severe labial agglutination

“…In the pediatric age group, a number of therapeutic regimes have been proposed. These include blunt and/or sharp dissection under anesthesia [16,17], manual separation with/without anesthetic [20], application of topical estrogen [12,18,19,21], and oral estrogen [22].The success rate in any of the regimes has been shown to be as high as 90% with the rate of recurrence after surgical or manual procedures ranging from 14 to 20%. In those using topical estrogen, recurrence was rarely seen.…”