Labial Adhesions

What are the signs and symptoms of labial adhesions?

Many girls with labial adhesions will not have symptoms. Some girls will experience genital pain, urinary tract infections or have difficulty urinating. Sometimes a girl with labial adhesions will complain about urine dribbling or leaking. This is the result of urine getting trapped behind the adhesion, then later leaking out.

What evaluation is used to diagnose labial adhesions?

Your daughter's doctor will often discover labial adhesions during a routine physical exam. If your daughter shows symptoms, her doctor will carefully review her health history and symptoms, then perform a physical exam, which includes looking at the external genital area. There is no specific test that is done to evaluate this condition and it is diagnosed based on history and external examination alone.

What to expect from the medical exam

The physical exam includes looking at the external genital area. The doctor may need to separate the labia majora (outer lips) to see and fully evaluate the adhesion. This may be uncomfortable for some girls but should not cause pain. The doctors at Children's Hospital Colorado's Pediatric and Adolescent Gynecology Department take special care to examine their patients with a level of sensitivity and empathy that makes them feel comfortable.

How are labial adhesions treated?

If a patient has no symptoms, medical treatment may not be necessary, and the adhesion may resolve on its own with time. In cases where the adhesion is small, we can use a non-medicated emollient or barrier cream for treatment, which helps to ease irritation and moisturizes the skin, making it more flexible. The emollient and barrier creams also help treat the underlying vulvovaginitis and prevents it from returning.

In cases where the adhesion is covering the vagina or causing symptoms, your child's doctor can use an estrogen-based cream or steroid cream, which can help to separate the tissue.

We only recommend surgical separation in rare cases, when the adhesion is very thick and topical treatment has failed.

If the doctor has prescribed estrogen cream for your daughter, apply a small (pea-sized) amount to the adhesion once or twice daily for at least two weeks or until instructed by the doctor. If you need to spread the labia majora to get to the labia minora, you can use a Q-tip or finger to apply the cream to the area where the labia minora are stuck. The area typically looks like a grey or white line. Once the labia have separated, a non-medicated emollient cream should be applied daily to prevent the labia from sticking back together and forming labial adhesions again.

These methods and techniques can help prevent vulvar irritation and recurrent labial adhesions:

• Change diapers frequently to avoid irritants on the skin.
• If toilet trained, dress your daughter in plain white, cotton underpants.
• Use unscented detergent and avoid fabric softeners or any extra cleaning or "freshening" products.
• Have your daughter wear a nightgown for sleeping (it's okay to let your daughter sleep without underwear).
• Your daughter should avoid wearing tights, one-piece leotards, tight jeans or leggings.
• Have your daughter take a bath every day and use clean, warm water only (no soap, vinegar or baking soda is needed). She should not use bubble bath or perfumed soap.
• Have your daughter gently pat her genital area dry.
• Talk about, and remind your daughter, how to wipe after a bowel movement.
• Encourage her to wipe from front to back after urinating.
• After swimming, make sure she changes into dry clothes right away.

Why choose Children's Colorado for care of labial adhesions?

Our board-certified pediatric and adolescent gynecologists have specialized training in the reproductive health concerns of girls of all ages. We understand that labial adhesions can be stressful. We will put families and patients at ease by carefully explaining the medical condition, discussing the various options for treatment, and supporting your family with follow-up visits and consultation with our colleagues in other specialties as needed.

Frequently asked questions (FAQs)

Here are some of the most common questions we receive from parents. For more information, please contact us at 720-777-2667.

• Will labial adhesions resolve on their own?
  Most labial adhesions will resolve spontaneously with the onset of puberty.
• Are there risks with topical estrogen cream?
  Short-term application of estrogen is very safe and rarely causes side effects. Some rare side effects from overuse can include growth and pigmentation of the labia and breast budding. These symptoms should go away once your daughter stops using the estrogen cream.
• How do I prevent the adhesions from recurring?
  Preventing the underlying condition of vulvovaginitis often stops the recurrence of labial adhesion.

Helpful resources

• The North American Society for Pediatric and Adolescent Gynecology provides multidisciplinary leadership in education, research and gynecologic care to improve the reproductive health of youth. The website provides online information and printable handouts about gynecological conditions, including labial adhesions.