Labial Adhesion

Today, I took my daughter in for her 9 month check up. Everything was great. She's healthy and on track with her development and growth. However, she has what is known as a labial adhesion. Since I had zero clue as to what this was, I have decided to research it and do a blog entry on it to not only inform myself but other Mommies and Mommy to be's as well.

• What is a labial adhesion?

Labial adhesions are a sticking together of the outer lips (labia) of the vulva. The vulva is the area outside of the vagina.This type of adhesion occurs most commonly in girls who are between 3 months to 6 years of age, and can persist until puberty.

• Signs and symptoms of labial adhesions

Some children with labial adhesions will have no symptoms, while others may have pain in the genital area, difficulty urinating, or frequent urinary tract (bladder) infections. The diagnosis is made by looking at the vulvar area and observing that the vaginal opening is either partially or fully covered by the labia with a white line indicating the adhesion. If your daughter is having symptoms such as pain, particularly when she is in a straddle position (for example, while sitting on a riding toy), or having trouble passing urine, you may have discovered that her labia appears to be stuck together. If your daughter has not had any symptoms, her health care provider may have noted the adhesions during a routine well-child check.

• What causes labial adhesions?

It is not clear why some young girls develop labial adhesions. It is thought that low levels of estrogen (that girls normally have during childhood) and vulvar irritation can result in the labia sticking together. Labial adhesion can develop as early as 6 to 8 weeks after birth.

Baby girls who have just been born don’t have labial adhesions because of high levels of estrogen passed on from the mother during pregnancy. Similarly, high levels of estrogen from puberty make it very unlikely for girls who are menstruating to develop adhesions.

• Treatment for labial adhesions

Whether or not treatment is recommended depends on how severe the adhesions are.

Small or mild adhesions do not cover the vaginal opening and may separate by themselves when your daughter reaches puberty or earlier. Your daughter’s health care provider will continue to watch how your daughter’s labia appear over time, and may recommend treatment if the adhesions get worse or cause symptoms.

Slightly larger or moderate adhesions that cover the lower part of the vagina may be treated with a mild emollient, such as A & D ointment®, along with gentle separation twice a day over several weeks.

Significant adhesions that cover the vaginal opening, and often the urinary opening as well, can be effectively treated with anestrogen-containing cream. These adhesions may prevent drainage of normal vaginal secretions, as well as impair the flow of urine. Sometimes this will cause urine to collect in the lower vagina, behind the adhesion, and can lead to irritation or dribbling of urine after your daughter stops urinating. If she develops a fever, it will not be possible to collect a clean urine specimen to see if she has a urinary tract infection. The most effective treatment for significant adhesions is an estrogen-containing cream applied twice daily for a period of time or until the adhesions resolve. This treatment requires a prescription from her health care provider.

Here is a photo depicting what each looks like:

My daughter is having to do the estrogen cream although her urethra is not covered to my knowledge. We will have to do it twice a day for two weeks or until the adhesion resolves. Then we will have to continuously apply Vaseline to that area.

• How will I know if the estrogen cream is working and is it safe to use?

Over time small openings will appear in the white line as the adhesion gradually disappears. Yes. Estrogen-containing creams are safe to use for the treatment of labial adhesions. Only a very small amount of estrogen cream will be used, for a limited amount of time. A few girls who are treated with estrogen cream may develop temporary small breast buds or darkening of the labia. Both of these conditions are not dangerous, and will go away once treatment is stopped. You should make an appointment with your daughter’s health care provider as soon as the (labial) separation is complete so you can stop the estrogen treatment and change to Vaseline® or A & D ointment®. If you are pregnant or worries about absorbing any estrogen, you can use medical type gloves (which you can buy in most pharmacies) while applying the estrogen cream.

• What if treatment doesn't work?

Reasons that the treatment fails may include applying the cream all over the vulva, instead of focusing just on the adhesion area or not applying enough cream. It is possible but rare that very thick adhesions won’t respond to treatment, even if the right amount of cream is used in the right area. If your daughter’s adhesions do not improve with the estrogen cream, you should discuss other treatment options with her health care provider. Some girls have success with a short course of steroid ointment.

• Is treatment necessary once the adhesions open up?

Labial adhesions can recur or come back, even after they open up. Once the labia are separated, Vaseline or A & D ointment is used as an emollient for 6-12 months to keep the labia open and prevent or lessen irritation of the vulva area.

Ways to help keep your daughter’s labia open:

1. Have her take a daily tub bath
2. After her bath, pat dry her vulva area with a soft towel
3. Apply a thin amount of A & D ointment to her dry labia

Harsh soaps, scrubbing the vulva, and tight clothing should be avoided.

Try to be patient with the course of treatment which can last up to several weeks, and possibly require additional follow-up visits to your daughter’s health care provider (HCP). If the labial adhesions come back, do not restart the estrogen cream again unless you have discussed this with her HCP.

Sources: Young Women's Health