Definition

• The labia minora (vaginal lips or folds) are stuck together
• Also called labial adhesions

Health Information

Symptoms

• The vaginal opening looks closed off.
• The fused labia start to close off at the back end first.
• Fusion can be partial or nearly complete. The urine stream keeps the front end open.
• A pale line is seen in the midline where the labia have fused together.
• The skin that holds the labia together is usually very thin. The longer it is present, the thicker it becomes.
• Usually, labial fusion doesn’t cause any symptoms. Sometimes, they cause painful urination or dribbling of urine.
• Peak age is 1 to 2 years. Range is 6 months to 4 years.

Cause

• Irritation of the labia and vulva from various factors. This causes them to become red or even raw. If the labia are touching when they heal, they sometimes heal stuck together.
• The most common irritant is soap. Examples are bubble bath, shampoo or soap in bath water. Soap can cause the genital area to become red, sore or itchy. This is called "soap vulvitis". Using a soapy washcloth can also be the cause.
• Stool from wiping back to front also can irritate the vulva.
• Diaper rashes can be the starting point.
• Girls are not born with labial adhesions.

Care Advice

1. Overview:
   • Labial fusion occurs in 3% of young girls.
   • It’s helpful to treat them early when the fused skin is thin.
   • They can be treated at home.
   • Here is some care advice that should help.
2. Estrogen Cream:
   • Estrogen creams can melt away (dissolve) the fused skin.
   • Estrogen creams are only available by prescription.
   • Use the cream as directed by your doctor.
   • Apply it to the thin line where the labia are fused. For it to work, it’s important to apply it to the right spot. Ask your doctor to teach you how to do this.
   • Use less than pea size. Put it on with your finger or a cotton swab.
   • Do this 2 times each day.
   • Continue for up to 4 weeks. If the labia come apart before 4 weeks, you can stop.
   • This is safe. The only side effect sometimes reported is early breast bud changes. This goes away after stopping the estrogen cream.
3. Petroleum Jelly to Prevent Recurrent Labial Fusion:
   • After the labia come apart, use an ointment to keep them that way.
   • Any ointment will do, but petroleum jelly (Vaseline) is a good choice.
   • Apply a small amount on both labia.
   • Do this once a day. Keep doing this for 1 month.
   • Before applying the ointment, cleanse the area with warm water. Do not use soap. After a bath is a good time.
   • After a month, slowly stop the ointment. Apply it once a week for another month.
4. Avoid Irritants to Prevent Recurrent Labial Fusion:
   • When your child bathes, cleanse the genital area with warm water. (Soap is not needed. until after puberty)
   • Don’t use bubble bath, shampoo or other soaps in the bath water. (Reason: They are irritants.)
   • Teach your daughter to wipe herself correctly from front to back after a stool.
   • Wear cotton underpants. (Reason: allow the skin to breathe.) Discourage wearing underpants during the night.
   • Avoid tight underwear or leotards.
5. Check Labia on Regular Basis:
   • Once a week, check your child to be sure the labia are still separated.
   • If they look like they are starting to seal over again, use an ointment.
   • Put it on once daily for a week.
6. Treatments to Avoid:
   • Forced Separation. Do not pull the labia apart with force. This will cause bleeding, pain and crying. It will also cause fear of having anyone look at the genitals. Also, your child will refuse to let you apply any cream there.
   • Any bleeding also increases the chances they will heal together.
   • Surgical Separation. Do not accept a referral to a surgeon for this problem. This is a medical problem that can be cured by estrogen cream and patience.
7. What to Expect:
   • With proper treatment, the labia will separate in 2 to 4 weeks.
   • Longer treatment is sometimes needed if the fused skin is thick.
   • If not treated, most will go away with puberty and natural estrogens.
   • The main reason to treat now is to keep fusion from getting worse.

Call Your Doctor If

• With treatment, the labia are not separated by 4 weeks
• Bladder infection is suspected
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

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