LABIAL ADHESIONS

This is one of those small problems in childhood which may cause great consternation when they are discovered but are in fact very minor and easily solved.

Presentation:

The usual story is that a parent or other carer of a girl in the toddler age group has suddenly noticed an odd appearance of her genitalia with a fleshy membrane joining the labia minora (inner lips) of the vulva, completely concealing the vaginal opening and leaving only a very small opening at the front through which she passes urine. It looks as though she has no vagina at all, nobody can remember for sure whether any such organ has ever been seen and so naturally there is great concern.

Cause:

Many little girls at times have a minor degree of vulvitis, inflammation of the vulva due to low-grade infection. This is seldom sufficiently severe to cause any symptoms but there may have been some slight soreness or irritation. The inner lips of the vulva become sticky and, in the absence of oestrogen (the adult female hormone secreted from the ovaries at puberty, one of its effects is to change the surface membrane of the vulva and vagina) they adhere to each other and gradually become more firmly attached.

Treatment:

The treatment is to apply oestrogen cream to the membrane which then dissolves away almost magically within a few days. This is most conveniently done with oestriol cream 0.01%. There may be some surprise from the pharmacist since this preparation is generally used for old ladies (who may also have problems from oestrogen lack). Twice a day place a small blob of the cream on a finger and rub it into the central line on the membrane covering the vagina. As oestrogen is well absorbed through skin this is a job for mothers not fathers! Within a few days the membrane will start to dissolve and soon thereafter will separate completely. When this has happened stop the treatment.

Outlook:

Sometimes there is a tendency for the adhesions to recur; if they are just starting they can be separated painlessly but if they are more formed a few applications of the cream will be needed. This condition has no long term implications at all. Any tendency to recur usually ceases long before puberty.