What is Labial Adhesions?
Labial adhesion refers to the merging of the small or large skin folds (labia minora or majora) around the female private parts, often near the clitoris. It is sometimes also called synechia vulvae or labial agglutination. The precise reason why labial adhesions occur is not known. However, experts think that having low levels of the hormone estrogen could be a factor. As a result, patients usually use estrogen cream for treatment when they have symptoms.
What Causes Labial Adhesions?
Labial adhesion, or the joining together of the inner or outer folds of skin around the female genital area, is usually accidentally discovered because most of the patients don’t experience any symptoms. The exact cause of this condition is unknown, but it’s believed to happen when there are low levels of a hormone called estrogen. It is quite rare in women of reproductive age due to the higher hormone levels during this time.
It can sometimes develop in adults if there has been any form of injury or irritation to the genital area. This could be from childbirth, instances of sexual abuse, or any kind of genital surgery. Treatment typically involves separating the adhered skin and applying a cream that contains estrogen. Labial adhesions have also been known to occur after giving birth. Breastfeeding, along with irritation and injury sustained during childbirth, might be a contributing factor, as breastfeeding can lead to a drop in estrogen levels, creating a low estrogen state, which is believed to lead to adhesions. To avoid this, doctors recommend minimizing skin irritation and keeping the area clean. It might also help to resume sexual activity when it’s comfortable to do so.
Labial adhesions may also occur during menopause, another period of low estrogen in a woman’s life. In this stage, the genital area is more prone to irritation and inflammation, potentially causing the adhesion. Among menopausal women, the chance of this condition occurring increases if they have diabetes, a skin condition called lichen sclerosis, or less sexual activity.
Risk Factors and Frequency for Labial Adhesions
Labial adhesion, a condition that can impact as much as 2% of girls before puberty, usually presents around the age of two.
Signs and Symptoms of Labial Adhesions
Labial fusion, which is the joining of the lips around the vulva, often doesn’t show obvious signs or symptoms. It’s usually accidentally discovered during a routine check-up. This fusion usually happens near the clitoris and involves thin fibrotic tissue – a kind of scar tissue. This fusion can be slight or complete, even blocking the entrance to the vagina.
When symptoms do appear, they might include:
- Dribbling after urination
- Presence of blood in urine
- Pain or discomfort during urination
- Inflammation in the labial area
Women with this condition may also experience difficulty urinating or holding urine. Additionally, labial fusion might be linked with urinary tract infections (UTIs), leading to the need for treatment. Research suggests that women with labial fusion before puberty have an increased risk of UTIs. This makes it very important to conduct a physical exam, particularly of the genitourinary region. If labial adhesions are successfully resolved, the risk of UTIs can go down.
Testing for Labial Adhesions
Essentially, this condition is diagnosed based on a doctor’s clinical examination and evaluation. It doesn’t require any special tests like laboratory blood work or diagnostic imaging (like X-rays or scans) to confirm. The doctor will gather information from your symptoms, medical history, and physical examination to come to a conclusion.
Treatment Options for Labial Adhesions
If a patient does not show any symptoms, treatment is not required. The best course of action is to simply reassure the patient and their family and provide guidance on maintaining good hygiene. Labial adhesions, which is when the inner lips of the female genital area stick together, often resolve on their own within a year without any treatment, as it happens in around 80% of the cases.
However, when treatment is needed, it usually involves applying a type of cream that contains estrogen directly to the area. This method is often adopted when the patient has a urinary tract infection. Research has shown this approach to be successful in up to 90% of the cases. Another commonly used treatment is a topical steroid such as beclomethasone. While estrogen cream is the first choice for many, studies have found no significant difference in outcomes when comparing estrogen and beclomethasone.
It’s important to be aware that after applying the estrogen cream, some patients might experience minor breast tenderness and skin color changes in the treated area. As we lack studies on the effects of long-term use of topical estrogen in children, it’s advised to use the cream for the shortest time possible that still brings effective results.
Other treatments might include using a topical medication called betamethasone or resorting to surgical measures. Take into account that betamethasone use may result in skin thinning, an increased risk of hair follicle infection, skin redness, diminished hair growth, and itchy skin.
There’s no set treatment duration for any of these topical therapies. The guideline is to use them for the minimum amount of time necessary to solve the problem. These products are usually applied once or twice a day for up to six weeks. However, in some cases, it may be recommended to extend treatment up to three months. If topical treatments don’t work, surgery may be used to separate the adhesions.
Surgical intervention is usually only considered after trying topical treatments for a few weeks. The operation, which is done under general anesthesia, involves gentle traction to separate the adhesions.
Remember that regardless of the type of treatment used, labial adhesions can reoccur. They may continue to return until the female patient goes through puberty. Studies show that recurrence rates range from 11% to 14% with either topical or surgical treatments. Any recurrences can be managed with topical treatment or surgery. In some cases, manual separation accompanied by good hygiene practices and cleanliness could also be an effective treatment option.
What else can Labial Adhesions be?
These are some medical terms related to various conditions. Here’s a simple explanation of each one:
- Hymenal skin tags: Small pieces of skin hanging in the vaginal area
- Imperforate hymen: A condition where the hymen (a membrane in the female genitalia) entirely covers the vaginal opening
- Introital cysts: Lumps that grow at the vaginal entrance
- Mayer-Rokitansky-Kuster-Hauser syndrome: A condition in which a woman is born without certain reproductive organs including the vagina and uterus
- Ureterocele: An issue in the urinary system where the tube that carries urine from the kidney to the bladder bulges
- Urethral prolapse: A condition in which the inner lining of the tube that carries urine from the bladder to outside the body, protrudes outside the body
- Vaginal atresia: A birth disorder wherein the vagina is closed or absent
- Vaginal rhabdomyosarcoma: A rare and fast-growing cancer in the muscle cells of the vagina
