My little girl patient, who was brought with the complaint of urinary incontinence, was
sitting opposite me with her head down. As I dig deeper into her story, I learn that she
doesn’t have incontinence at night, she urinates at regular intervals during the day, but her
panties get wet after each urine.
We doctors often diagnose the disease at the stage of talking with the patient. I guess what
can happen in my mind, as I question my patient and deepen my anamnesis. As a matter
of fact, I see that the labia are almost completely adhered while doing the examination.
Labial adhesion is a problem seen in about one in thirty girls. The structures that make up
the female external genital organ are called “vulva” in our language. Babies have the
oestrogen hormone that comes from their mothers when they are first born. Over time, this
hormone disappears, and they go through a period of low oestrogen until the young
maiden period begins and secretes their own hormones. During this period, exposure of
the vulva to continuous damage due to diaper rash, poor hygiene, sensitivity to cleaning
materials, and skin tissue prone to allergies is considered among the causes of labial
One of my professor friend used to say “meticulous mother’s disease”. Of course, mothers
trying to scrape the area thoroughly to clean is also a cause of damage.
In the end, although the cause is not known exactly, it is necessary to know that it is not a
congenital pathology, an important information for private insurances. During the injury of
the vulva, the epithelium on the small lips is damaged, while it heals again, it can heal by
sticking to the opposite lip, and then a vascular membrane is formed between both small
lips. This is what we call labial adhesion, labial fusion or labial adhesion.
Most children do not show any symptoms, as natural oestrogen increases in adolescence,
it can pass by itself. Sometimes it can cause problems, especially if it is much closed. In a
study where we examined the files of 120 children, most of the children didn’t report any
complaints, and were brought under routine paediatrician supervision or in the bathroom
by parents noticing. On the other hand, some patients had itching, rash, urinary tract
infection and genital discharge in the genital area. 13% of the patients had complaints of
dripping after urination and panties getting wet, like the little girl I described in previously.
I already stated that in eight of ten patients, it may disappear spontaneously. Of those that
disappeared, four out of ten can reoccur. So don’t be surprised if you witness that it
happened to your daughter, then disappeared and then happened again.
When and how do we treat?
Our approach in treatment is as follows: If there is less than 50% adhesion, we send the
patient back to the family by explaining the importance of hygiene and care without harm.
If there is more than 50% of the adhesion and especially the complaints I have just
mentioned, we try to open it more conservatively with local creams before manually
opening it. Because in any case, they can relapse after treatment.

What creams do we give?
Traditionally oestrogen creams are used. If it is applied too much, side effects such as
darkening of the external genital organ, hair growth, and enlargement of the breasts may
occur. Therefore, some people choose to use steroid creams. However, their long-term
side effects are unknown. In a study that we conducted with 131 patients, we could not
find a significant difference between both. But when the two are used together, the
efficiency is more. We use it together in the cases that do not heal easily and recur
constantly. We tell the family how much to apply and how long to use it for. We definitely
apply petroleum jelly or moisturizing creams to save time for the healing of the area.

What if we can’t cure it with local care?
Whatever we do, it can stick again, so maintenance is very important. If creams can’t solve the issue, we, as a paediatric surgeons, open it manually. We apply a local anaesthetic cream on young children, wait for a while and then separate the adhesion in polyclinic conditions; in the slightly older ones, due to the sensitivity of the region, we can easily give a smell of
 gas in the operating room and do the procedure under general anesthesia.
In conclusion, it is a problem that you need not to get afraid about and it can go away on its own. In cases that require treatment, the priority is local treatment. If local treatment cannot be performed or is not effective, surgery steps in.
We have come to the end of another course. As always, you can find the links to our
articles I mentioned in the blog below.
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And stay happy.
Manual separation, topical vaseline and estrogen in labial adhesions
How Should We Treat Prepubertal Labial Adhesions? Retrospective Comparison of Topical Treatments: Estrogen Only, Betamethasone Only, and Combination Estrogen and Betamethasone