Labial adhesions : University College London Hospitals NHS Foundation Trust

What are labial adhesions?

The labia are folds of skin that are around the entrance to the vagina and urethra (opening where urine comes out). There are inner labia (labia minora) and outer labia (labia majora).

Labial adhesions are also known as labial fusion. It describes when the inner labia in children fuse together.

Labial adhesions are often not noticed because they rarely cause problems. Most children have no issues and the adhesions are noticed by chance (eg. during nappy changing).

A small number of children might have issues with adhesions causing dribbling of urine and this can affect toilet training. It’s rare for labial adhesions to cause problems with urine infections or not being able to pass urine.

Labial adhesions do not cause any problems in future life. They do not cause difficulties with periods, fertility or sexual activity. It’s very rare for labial adhesions to persist beyond puberty. If they do persist, they can be managed surgically.

Despite being common it’s not certain why labial adhesions happen. Low oestrogen levels in childhood means that the skin of the vulva is more likely to become irritated which could lead to fusion.

The diagnosis is made by clinical examination. This is an external examination of the vulva. There is no internal examination and no scans are required.

No active treatment to separate the adhesions is recommended in young children who are not having any problems. General vulval care measures are recommended to help reduce irritation. The labial adhesions should open up as a child grows and goes through puberty. Puberty can start from 8 years onwards, when the ovaries start to produce oestrogen hormone.

When labial adhesions are causing issues then a short course of oestrogen cream can help to open up the fusion. A small pea-sized amount should be gently applied over the line of fusion with a clean fingertip or cotton bud. The cream is applied twice daily for six weeks. Sometimes the oestrogen cream can cause some early breast development - this should go away when the oestrogen cream is stopped. Oestrogen cream treatment is not recommended for children without symptoms because of potential side effects and because the adhesions can reform.

Surgical separation is rarely required.

Vulval care involves avoiding anything that can irritate the vulva. Toilet hygiene is important for this: teach your child to wipe from front to back, and wash their hands after using the toilet.

Wash the vulva with water or a sensitive fragrance-free wash. Wet wipes should be avoided.

Loose fitting, cotton underwear and using non-biological detergents for washing can help reduce irritation.

Having vulvovaginitis and needing examinations by doctors can be a good opportunity to talk to your child about staying safe. Take a look at PANTS (The Underwear Rule), an excellent on-line resource which the NSPCC offer.

The paediatric gynaecology clinic is in the children and young people outpatient department. This is on the lower ground floor of the Elizabeth Garrett Anderson Wing.