The fused labia

LABIAL adhesions, or fused labia, according to obstetrician-gynaecologist at ICON Medical Centre Dr Keisha Buchanan, occur when the labia (outer lips) are fused together. She said that this type of adhesion is most common among girls three months to six years of age, and can persist until puberty.

“The labia are the rounded folds of skin and fat outside of the vagina. It is the visible portion of the vulva. It consists of two parts — the labia majora and the labia minora, the latter being the smaller inner labia,” Dr Buchanan said

Labial fusion (adhesion), which she says occurs in two to three per cent of young girls, is caused by a lack of oestrogen. She said that while it is more common in young children, labial adhesion also occurs in menopausal and postpartum women (first six weeks after pregnancy).

Dr Buchanan said that during pregnancy the baby gets oestrogen from the mother. After birth, the levels of oestrogen fall off and the labia get more vulnerable to irritation. Irritation from wet diapers, dirty diapers, scented detergent and soaps, for example, along with decreased oestrogen, causes the labia minora (the inner labia) to fuse. The fusion occurs from the back part of the labia to the front and is usually partial, but can be complete as well.

As expected, many parents and women affected will be quite alarmed by the physical appearance; however, Dr Buchanan notes that it is not a serious cause for concern; however, it could offset some gynaecological conditions.

“Usually labial fusion causes no problem and many times goes unrecognised or is accidentally discovered by the paediatrician in the case of small children. It causes no health problems, and any related issue is usually irritation and/or redness in the genital region. Labial fusion, however, may predispose a young girl to conditions such as bladder infections,” Dr Buchanan said.

Other conditions such as recurrent urine drainage, vaginal discharge and infection may occur due to urine pooling in the vagina, and the child might not want to pass her urine owing to fear of pain which might occur. Rarely is the fusion so severe that it causes obstruction of urine flow and retention of urine.

“In most cases, no treatment is needed for labial fusion, and the parents don’t need to do anything. However, you should always take the child to see a paediatrician when this is discovered. Parents should never attempt to tear away or infuse the labia as it will be painful, may bleed or swell up. If treatment is needed, the doctor may prescribe a steroid cream or oestrogen cream.”

She said application of these creams will usually cause the fusion to resolve; however, underlying bladder infections will need to be treated with antibiotics. For the more severe cases, Dr Buchanan said that surgical resection of the fusion under anaesthetic may be needed.

Following treatment, Dr Buchanan said that there will be a need for regular examination to monitor for recurring fusion. However, the general recommendation is that the area should always be lubricated using petroleum jelly or baby salve after each diaper change, maintaining good hygiene such as ensuring that diapers are changed as soon as they are wet, and avoiding scented detergents in order to prevent recurrence.

“In women, treatment with steroid or oestrogen creams may be needed, and even surgery in rare cases. For postpartum women, the labial fusion will resolve as soon as the menstrual cycles restart and the oestrogen levels rise and return to normal. In the case of girls who have recurrent fusions, this will resolve with the onset of puberty as the oestrogen levels start to rise. In the case of menopausal women, repeated use of oestrogen creams will help to prevent the fusion from recurring,” Dr Buchanan advised.