Postmenopausal labial agglutination mimics urinary incontinence and hidden vaginal lesion

Abstract

Labial agglutination has rarely been reported in postmenopausal women and its treatment has been based on experience with prepubertal girls. We describe an 83-year-old woman who presented with labial agglutination and severe urinary incontinence. She had been treated intermittently with a topical estrogen cream for 3 years, but her symptoms persisted. Surgery was performed and her urinary incontinence was instantly resolved. Incidental vaginal low-grade squamous intraepithelial neoplasia was noted. Later, the lesion progressed and was confirmed to be condyloma acuminata. No recurrence of labial agglutination was noted 3 months after the surgery. We emphasize that surgical intervention should be the first consideration for labial agglutination with urinary symptoms in postmenopausal women. This case also highlights that surgery can not only resolve patients' symptoms early, but can also enable access to the region for essential gynecologic procedures.

A novel surgical treatment for labial adhesion – The combination of Z- and Y-V-plasty: A case report

“…Although topical oestrogen with vulvar hygiene is regarded as a first-line treatment for prepubertal girls and has been known to yield favourable outcomes [ 7 ], this treatment often has no therapeutic effects in postmenopausal women [ 9 ]. Moreover, labial agglutination interferes with gynaecological examinations, such as Pap smear tests or ultrasound, leading to the inability to diagnose vaginal pathological conditions [ 5 ]. Thus, surgical intervention is more likely in older patients with severe disease.…”

“…Patients with labial adhesions rarely complain of the symptoms unless the fusion is almost complete. Severe fusion manifests as various non-specific symptoms, such as urinary incontinence, dysuria, vulvar irritation, and urinary tract infections [ 5 ].…”