A girl with Labial Adhesions (VulvalSyncechiae)

A 1.5 year old girl was brought with complaints of dribbling of urine, pain while passing urine and redness near urinary opening. She was seen elsewhere and the parents were told that the child has an absent vagina. She was finally referred for treatment to Dr A.K.Singal, expert & renowned Pediatric urologist in Navi Mumbai, India.

On examination by an expert Pediatric urologist- the child had a condition called "Labial Adhesions" where the inner parts of skin of vulva get fused due to some local infection. This gives the false impression of absent vaginal opening. As the urine is not fully passed outside, this can lead to urinary infections and local infections.

Dr Singal started the child on medical treatment using a mild estrogen ointment for twice a day with an aim to avoid surgery. Within two weeks the adhesions separated and vaginal opening could be seen well. The surgery could be avoided. At one month, the child had normal looking vaginal opening and the parents were overjoyed.

Medical treatment of Labial Adhesions in children:

Labial adhesions are managed without surgery these days by use of mild hormonal creams which cause maturation of the skin in children and separation of the labial fusions. For the last five years, we have been treating a large number of girls with labial adhesions without surgery.

Minor surgery for Labial Adhesions in children:

For girls who do not respond to medical treatment for labial adhesions, a short procedure was performed in outpatient department and these adhesions can be separated. The procedure can be done in clinic after application of local anesthesia cream. The adhesions are separated using a mosquito forceps. Post separation, the importance of keeping the area clean is stressed and a hormonal ointment is also prescribed for local application.

About Labial Adhesions

Labial adhesions (or vulval synechiae) are a very common condition in young girls till the age of 5-6 years. In this condition the Labia Minora- or the inner labia, get fused to each other.Girls with Labial adhesions come to clinical attention because of local irritation/ itching, urinary infections, post void urinary dribbling or sometime when severe with difficulty in passing urine. Labial adhesions may also impede urine flow and also may promote urine entry into vagina. Most of the time, the issues with labial adhesions are minor.

Diagnosis of undescended tests is made on an expert clinical examination only.

Treatment is done by separation as an short Outpatient procedure plus application of estrogen ointment post procedure for 7-10 days. Minor labial adhesions can be managed by application of Vaseline jelly and separation with the help of an earbud at home by the mother. Perineal hygiene should be taught to the mothers.Labial adhesions have a tendency to recur in about 10-20% of the cases.