When the inner lips (labia minora) of the vagina become stuck together, it is called a labial adhesion. This is typically seen in girls between the ages of 3 months and 6 years old. Labial adhesions can partially or completely block the opening to the vagina and the urethra (where urine comes out). Most of the time, labial adhesions do not cause any symptoms at all! Rarely patients may notice changes in the urine stream, dribbling urine after urinating, vaginal discharge, or bladder infections. In these cases, the adhesions may need to be treated.
As a pediatric gynecologist, I can tell you that adhesions are much more common than many might realize. In fact, it’s estimated that about 2 out of every 1,000 girls will develop them before they reach puberty[i]. Parents should be relieved to know that adhesions do not cause long term issues and most of the time adhesions do not require any treatment. Here are a few more facts about labial adhesions:
What causes labial adhesions?
Physicians believe that labial adhesions develop from a combination of inflammation, trauma or infection that occurs in a low estrogen environment. Newborns have estrogen in their bodies from their mothers, and it can take several months for the hormone to decrease. Adhesions are most likely to first appear between the ages of 13 and 23 months – a time when the leftover estrogen has disappeared and when babies are becoming more physically active.
What are the symptoms of labial adhesions?
Most children will have no symptoms at all. Some children may complain of vulvar pain, itching or irritation or they may have trouble completely emptying their bladder, and urine may continue to dribble out well after they have finished using the potty. Children with labial adhesions can also experience recurrent urinary tract infections or vaginal discharge.
How are labial adhesions diagnosed?
Adhesions are diagnosed by visual examination that reveals that the inner lips of the labia (labia minora) are stuck together. Many times, adhesions are discovered by a parent during diaper changes or by a physician during a routine well child check-up.
How are adhesions treated?
Thankfully, if the adhesion isn’t causing any medical problems, we will suggest waiting to see if the labia will unstick on their own during puberty – when the body begins producing its own estrogen. If adhesions are significantly blocking urine flow, or causing recurring vaginal or bladder infections, physicians may prescribe an estrogen or steroid cream to put on the labia. Because estrogen can have side effects that mirror puberty – only a tiny amount of the cream is used, and for a short time. Parents will be instructed to apply gentle pressure to the adhesion while applying the cream to help the labia become unstuck. In very rare cases, the labia may need to be separated in a doctor’s office. This is done using local or general anesthetic to prevent any discomfort for your daughter.
Can labial adhesions come back?
Yes – it is very common for adhesions to come back until the child enters puberty and begins to make their own estrogen.
The discomfort and irritation caused by labial adhesions can mimic many other gynecological issues, so if your baby or child is having symptoms, it’s best to see a pediatric gynecologist or urologist. You can request an appointment with Nationwide Children’s Pediatric Gynecology experts online or by calling (614) 722-2250.
[i] Leung AK, Robson WL, Tay-Uyboco J. The incidence of labial fusion in children. J Paediatr Child Health. 1993 Jun. 29(3):235-6. [Medline].