What is Labial Fusion (Adhesion, Union) in Girls?

Labial fusion, or more rarely known as “labial adhesion,” is a condition in which the inner genital lips (labia minora) stick together, especially in young girls or babies. It is also referred to by different names such as labial synechia, vulvar adhesion, vulvar fusion, and labial adherens. This condition involves the closure of the entrance to the vagina, and sometimes even the urethral opening, by a thin, white-blueish tissue.

 

 

Who Does Labial Fusion Affect?

Labial fusion is most commonly seen in girls between the ages of 13 months and 6 years. Its prevalence ranges from 1% to 39%. The labia (the lips of the girl's external genital organs) may be partially or completely fused. This is not congenital and usually occurs during the diaper period. In some babies, it can be seen as early as the first 1-2 months of life. In some children, it may even appear after they have been potty trained and no longer wear diapers.

The fusion can start at the lower corner and progress toward the clitoris, i.e., the upper part of the vagina. Although the exact cause is unknown, it is thought to be related to irritation of this area in girls with low estrogen levels before puberty.

What is the cause of labial fusion (adhesion) in girls?

Its appearance before puberty may indicate a connection with estrogen hormone deficiency. It generally appears in babies 6-8 weeks after birth. Until this period, the estrogen hormone passed from the mother's placenta during pregnancy is protective. It is observed in 2-5% of all babies. It is more common in girls between 3 months and 6 years of age.

Frequent internal and external genital infections, allergic diseases, washing the genital area with soap, and chronic irritation caused by the use of vaginal tampons and diapers that cause dermatitis can cause the lips to stick together.

Is There a Classification of Labial Adhesion?

Adhesions in the inner labia can be classified as complete (total) or partial (incomplete).

What Are the Consequences if Labial Fusion Is Not Treated?

Incomplete adhesions generally do not cause problems in girls. However, complete adhesions can block the flow of urine and even cause it to flow backward, leading to urinary tract infections. It can also cause difficulty urinating (forked and difficult urination) and frequent urinary tract infections (related to the closure of the urinary opening). In older children, it can cause problems such as genital itching, burning, and pain. If the fusion is complete, it can also close the entrance to the vaginal canal, leading to problems with menstruation.

However, it should be noted that this condition is quite rare after the age of 5-6. If such a situation is encountered, the patient must be evaluated for vaginal atresia.

What are the symptoms of labial fusion?

The condition often progresses without symptoms. In infants, it is often detected during a routine examination by the mother or physician. In older girls, the aforementioned menstrual issues may be present, or if there is complete fusion, urinary issues, urinary tract infections, and associated symptoms may occur.

How is it diagnosed?

It is diagnosed through physical examination. It must be distinguished from vaginal atresia. During the examination, the external genital area appears flattened. The inner lips (labia minora) are either very small or non-existent.

How is labial fusion treated?

Labial fusion treatment methods vary depending on the age of the patient, their complaints, and the level and location of the adhesions.

Most labial adhesions in childhood resolve on their own, with 80% of patients experiencing spontaneous separation within 1 year, so there is no need for excessive concern. Labial fusion separation is not recommended unless there are aesthetic concerns.

Treatment begins with attention to genital hygiene, and cleaning with natural cotton cloths and water is generally recommended. Menthol-containing cloths are not recommended. However, if there is an infection, antibiotic medications and creams may be prescribed. Subsequently, estrogen-containing creams are applied locally with massage, typically in three courses with a 15-day interval between each course, and the results are generally successful. However, since the creams contain hormones, they should be used under the supervision of a physician, as with other medications. If used for a long time, they may cause side effects such as breast enlargement and hair growth.

How is Labial Fusion Opened?

First of all, it is important to reiterate that labial fusion should only be opened if there are functional problems. Surgery should only be performed if the child cannot urinate or empty their bladder. Under no other circumstances should it be performed. The surgical procedure should be performed in an operating room under sedation, as it is a painful procedure.

After labial adhesions are separated, topical estrogen therapy (in cream form) may be administered for 1-3 weeks. Subsequently, the use of petroleum jelly for 4-6 months helps prevent the adhesions from reforming.

Does Labial Fusion Recur After Treatment?

Yes, it can recur. It can recur up to the age of 5-6, but not after that age. If it recurs, the same treatment program is applied.

*** The information provided here is intended to inform visitors, particularly families, about the content of the website. No information should be considered as advice by visitors and should not lead to any decisions or actions. Families should have their child examined by a pediatric surgeon, consult with them, and make decisions based on their individual advice.