Labial fusion
Introduction
Labial fusion, or labial adhesion, is when the small lips around the entrance to the vagina (the labia minora) become sealed together and covered with a fleshy membrane. It is sometimes seen in babies and young girls.
The membrane usually completely seals the vaginal opening, leaving a very small gap at the front through which urine passes.
For most babies or girls, labial fusion does not cause any problems and is often discovered accidentally by a parent or carer. Occasionally, labial fusion can lead to infection, an abnormal stream of urine, vaginal discharge and pain in the vaginal area (see Labial fusion – symptoms for more information).
Key facts
- labial fusion is quite a common condition in babies and young girls
- it does not usually cause any problems
- it is not related to other conditions
- a fusion will usually separate naturally
- treatment is not usually recommended or needed
Who is affected
Labial fusion is fairly common, affecting 2-5% of babies and young girls aged between three months and six years. It is most common in girls between the ages of one and two.
The problem is rarely seen in girls after they begin puberty, because this is when they start to produce the hormone oestrogen. Oestrogen makes adhesions of the labia less likely to occur.
Why it happens
It is not certain what causes labial fusion, but it usually occurs as a result of some irritation or inflammation (swelling) of the vaginal area. This can cause the inner lips of the vulva to become sticky and, without enough oestrogen in the body, the lips can stay stuck together and gradually become firmly attached.
Outlook
A labial fusion usually separates naturally over time. In 8 out of 10 cases, a fusion corrects itself within a year. There is a risk of a fusion recurring (see Labial fusion – complications), but this tendency usually stops before puberty begins.
Treatment for labial fusion is not recommended unless there are other symptoms, such as an obstructed urine flow, that may cause problems or discomfort. Treatment is with oestrogen cream or ointment applied daily, or rarely, surgical separation (see Labial fusion – treatment for more information).
Labial fusion is not linked to any medical condition and has no long-term implications for your child - it will not affect their fertility or future sexual life.
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Symptoms
Labial fusion describes how the two sides of the labia (lips around the entrance to the vagina) can stick and join together. A fusion can occur along the entire length of the labia or just in one section. There is usually an opening through which urine can pass, but in some girls the opening may be very small and not clearly visible.
The membrane covering the vulva is like a skin – it can be thin and translucent or fairly thick.
Other possible symptoms
Labial fusion does not normally cause any problems. Rarely, it can lead to:
- infection, such as a urinary tract infection
- vaginal discharge
- soreness or pain in the genital area (may be noticed when riding a bike or horse)
- a disrupted flow of urine
In some cases, a fusion can trap urine in the vagina, which can result in dribbling and leaking of urine between visits to the toilet.
Diagnosis
Because labial fusion does not usually cause any symptoms, it is often only noticed by parents during nappy changing or bathing. Your GP can confirm labial fusion after doing a routine examination of the child’s genital area.
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Treatment
A labial fusion or adhesion usually separates naturally. Eventually, when the child goes through puberty, the production of the hormone oestrogen causes the labia (lips around the entrance to the vagina) to separate.
If fusion of the labia is not causing any problems, treatment is not usually recommended.
If your child has symptoms, such as an infection or abnormal urine stream, treatment may be recommended to prevent further problems. Treatment can involve oestrogen cream or ointment. In rare circumstances, surgical separation is needed.
Oestrogen cream or ointment
Oestrogen cream or ointment is usually the treatment offered for labial fusion. Your GP will recommend an appropriate medication.
A small blob of the cream or ointment is applied daily onto the central line of the membrane covering the vagina. This should be continued for a few weeks until the membrane starts to dissolve and the labia eventually separate completely. When the membrane dissolves, you should stop applying the cream.
To enable the labial edges to heal properly and prevent another labial fusion forming, you should continue to apply an emollient cream, such as a nappy rash cream, for a few months after the fusion has separated.
Surgery
Surgery may be considered if:
- an oestrogen cream or ointment does not work
- a fusion is particularly thick and severe
- there is any trapped urine in the vagina, which could lead to an infection
Labial fusions are relatively easy to separate – they can usually be gently pulled apart by hand, or a small blunt probe is used. A surgical separation is usually performed under a general or local anaesthetic, as the procedure can be quite painful and can cause distress (a general anaesthetic means you are put to sleep; a local anaesthetic means numbing the area).
To allow the labial edges to heal properly and prevent another labial fusion forming, you will be advised to apply an emollient cream, such as a nappy rash cream, to the labia for a few months afterwards.
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Complications
Recurrence
Reccurence of labial fusion is fairly common and has been reported in as many as 14% of cases.
However, using an emollient cream after the labia have separated can stimulate healing and prevent the membrane forming again.
Side effects from oestrogen
Oestrogen creams and ointments can occasionally cause side effects, especially if used for periods longer than a few weeks. Side effects can include:
- slight amounts of breast budding or enlargement
- irritation around the genital area
- temporary pigmentation (darkening) of the skin in the genital area
- vaginal spotting or bleeding after you stop using the cream or ointment
Side effects should go away after you stop using the oestrogen cream or ointment.
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Prevention
Labial fusion sometimes occurs after inflammation and irritation in the labial area (area outside the vagina). A common cause of this in young girls is an infection called vulvovaginitis.
Vulvovaginitis can cause itching in the vaginal area, vaginal discharge, inflamed skin and a burning or stinging sensation when passing urine. Most girls will be affected at some stage before they reach puberty, but it is not a serious problem, and treatment is not normally needed.
The lining of the vulva and vagina can be quite thin in young girls and easily irritated. Causes of vulvovaginitis include:
- moisture and dampness around the vulva, which can be made worse by tight clothing and being obese
- irritant products, such as soaps and bubble bath
To prevent vulvovaginitis and irritation in the vaginal area, you should:
- avoid tight trousers and make sure your child wears fairly loose cotton underwear
- get advice if your child is overweight
- avoid using too much soap and other products on your child in the bath or shower, and rinse away products thoroughly
- make sure you keep your child’s genital area clean and dry
Using soothing creams, such as a nappy rash cream, can help to settle any soreness in the vaginal area and help to protect the delicate skin in the area.
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