Labial adhesions commonly occur in pre-pubertal girls. The thinner labia minora adhere in the midline. It is not a pathological finding but is considered a normal variant. There will be an aperture through which urine is passed but this may look small or there may be more than one aperture. There will be a thin line of fusion of the tissues visible in the midline. The clitoris and perineum will otherwise look normal. With development, particularly at the time of puberty with increased circulating oestrogens, these adhesions will separate spontaneously.
Most girls with labial adhesion do not have any symptoms and the usual concern of the carer is the appearance of the external genitalia. These girls do not need to be seen at the surgical clinic.
A small number of girls may complain of discomfort in the genital area, lower urinary tract symptoms and rarely urinary tract infection. This would merit management as below.
- Simple reassurance.
- For those girls with symptoms simple hygiene and bathing advice is appropriate e.g. care when wiping after voiding, avoiding perfumed bath products and biological washing powders, wiping from front to back when washing, ensuring a good fluid intake and regular voiding.
- For symptomatic girls who do not respond to simple hygiene measures, topical treatment to the labial adhesion with an oestrogen containing cream (twice daily for 6 weeks) may allow the labial tissue to become more supple and the adhesions may open up and separate. The adhesions may reform once the cream is discontinued. This therapy can be safely prescribed in primary care without paediatric surgical review. It should be noted that whilst this treatment is Specialist recommended, it is not currently on formulary, however an application has been made to have this treatment included in the formulary. There is advice in the BNFC regarding this treatment.
- For symptomatic girls who do not respond to simple hygiene measures or oestrogen then a surgical review may be beneficial.
FM, LS, JB Sept 22
Who to refer:
Girls who have symptomatic labial adhesions who do not respond to simple hygiene measures or oestrogen.
Who not to refer:
Any pre-pubertal female child with asymptomatic labial adhesions
How to refer:
Referral is via SCI Gateway
Referral Priority
Symptomatic labial adhesions will be classed as a non-urgent referral.
Surgical Priority
Separation of labial adhesions is classed as a non-urgent procedure.
Options for Management in Primary care
- Simple reassurance.
- For those girls with symptoms simple hygiene and bathing advice is appropriate e.g. care when wiping after voiding, avoiding perfumed bath products and biological washing powders, wiping from front to back when washing, ensuring a good fluid intake and regular voiding.
- For symptomatic girls who do not respond to simple hygiene measures, topical treatment to the labial adhesion with an oestrogen containing cream (twice daily for 6 weeks) may allow the labial tissue to become more supple and the adhesions may open up and separate. The adhesions may reform once the cream is discontinued. This therapy can be safely prescribed in primary care without paediatric surgical review.
- For symptomatic girls who do not respond to simple hygiene measures or oestrogen then a surgical review may be beneficial.
