Labial fusion is a medical condition of the

vulva In mammals, the vulva (: vulvas or vulvae) comprises mostly external, visible structures of the female sex organ, genitalia leading into the interior of the female reproductive tract. For humans, it includes the mons pubis, labia majora, lab ...

where the

labia minora The labia minora (Latin for 'smaller lips', : labium minus), also known as the inner labia, inner lips, or nymphae, are two flaps of skin that are part of the primate vulva, extending outwards from the inner Vagina#Vaginal opening and hymen, vagi ...

become fused together. It is generally a pediatric condition.

Presentation

Labial fusion is rarely present at birth, but rather acquired later in infancy, since it is caused by insufficient

estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...

exposure and newborns have been exposed to maternal estrogen ''

in utero The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more fertilized eggs until bir ...

''. It typically presents in infants at least 3 months old. Most presentations are asymptomatic and are discovered by a parent or during routine medical examination. In other cases, patients may present with associated symptoms of

dysuria Dysuria refers to painful or uncomfortable urination. It is one of a constellation of ''irritative'' bladder symptoms (also sometimes referred to as lower urinary tract symptoms), which includes nocturia and urinary frequency. Diagnosis The cl ...

urinary frequency Frequent urination, or urinary frequency (sometimes called pollakiuria), is the need to urinate more often than usual. Diuretics are medications that increase urinary frequency. Nocturia is the need of frequent urination at night. The most common ...

, refusal to urinate, or post-void dribbling. Some patients present with

vaginal discharge Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, ...

due to pooling of urine in the

vulval vestibule The vulval vestibule (also known as the vulvar vestibule or vestibule of vagina) is the part of the vulva between the labia minora. At the innermost part are the vaginal introitus and urinary meatus. The Bartholin's and Skene's glands each ha ...

or vagina.

Complications

Labial fusion can lead to

urinary tract infection A urinary tract infection (UTI) is an infection that affects a part of the urinary tract. Lower urinary tract infections may involve the bladder (cystitis) or urethra (urethritis) while upper urinary tract infections affect the kidney (pyel ...

, vulvar vestibulitis and inflammation caused by chronic urine exposure. In severe cases, labial adhesions can cause complete obstruction of the

urethra The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate. The external urethral sphincter is a striated ...

, leading to

anuria Anuria is nonpassage of urine, in practice is defined as passage of less than 100 milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occur because of some severe obstruction like kidney stone ...

and

urinary retention Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include urinary incont ...

Pathophysiology

The primary contributing factor to labial fusion is low estrogen levels. A vulva with low estrogen exposure, such as that of a preadolescent, has delicate epithelial lining and is therefore vulnerable to irritation. Conditions causing irritation, such as infection, inflammation and trauma, cause the edges of the labia minora to fuse together. The fusion typically begins at the posterior frenulum of the labia minora and continues anteriorly. Most labial adhesions resolve spontaneously before puberty as estrogen levels increase and the

vaginal epithelium The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (Epithelium, squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie u ...

becomes cornified.

Diagnosis

The condition can be diagnosed based on inspection of the vulva. In patients with labial fusion, a flat plane of tissue with a dense central line of tissue is usually seen when the

labia majora In primates, and specifically in humans, the labia majora (: labium majus), also known as the outer lips or outer labia, are two prominent Anatomical terms of location, longitudinal skin folds that extend downward and backward from the mons pubis ...

are retracted, while an anterior opening is usually present below the

clitoris In amniotes, the clitoris ( or ; : clitorises or clitorides) is a female sex organ. In humans, it is the vulva's most erogenous zone, erogenous area and generally the primary anatomical source of female Human sexuality, sexual pleasure. Th ...

Treatment

Treatment is not usually necessary in asymptomatic cases, since most fusions will separate naturally over time, but may be required when symptoms are present. The standard method of treatment for labial fusion is the application of topical estrogen cream onto the areas of adhesion, which is effective in 90% of patients. In severe cases where the labia minora are entirely fused, causing urinary outflow obstruction or vaginal obstruction, the labia should be separated surgically. Recurrence after treatment is common but is thought to be prevented by good hygiene practices. One study has shown that

betamethasone Betamethasone is a corticosteroid, steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic co ...

may be more effective than estrogen cream in preventing recurrence, with fewer side effects.

Epidemiology

Labial fusion is not uncommon in infants and young girls. It is most common in infants between the ages of 13 and 23 months, and has an incidence of 3.3% in this age group. It is estimated that labial fusion occurs in 1.8% of all prepubertal girls. It is rare in adult women, particularly in reproductive age, but is occasionally found in postpartum and postmenopausal women.

References

External links

Labial adhesions
at

Medscape Medscape is a website providing access to medical information for clinicians and medical scientists; the organization also provides continuing education for physicians and other health professionals. It references medical journal articles, Con ...

{{Medical resources , DiseasesDB = , ICD10 = {{ICD10, Q, 52, 5 , ICD9 = , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = article , eMedicineTopic = 953412 , MeSH = , GeneReviewsNBK = , GeneReviewsName = Gynaecologic disorders Pediatrics