The term, vaginal adhesion, refers to a common disorder in prepubescent girls where the labia minora, or lips of the inner vagina, fuse together. The condition often causes no symptoms or discomfort. Parents usually notice that the vaginal opening appears closed while bathing or changing the child, or a pediatrician may identify the condition during a routine check-up. Vaginal adhesions resolve on their own within one year in up to 80 percent of cases.
Causes of Vaginal Adhesions
In the past, adhesions were blamed on low estrogen levels, but subsequent studies indicate that this is not the case. It is believed that frequent irritation of vaginal skin causes the formation of labial adhesions. Wet diapers, harsh detergents, certain soaps, and contact irritation from ill-fitting clothing all irritate the vaginal skin of young girls. Additionally, some vaginal adhesions are associated with sexual abuse of the child and occur as a result of trauma and found in conjunction with lacerations and hematomas on the vagina. The raw skin attaches to skin on the opposite side during the healing process, causing the skin to adhere or grow together. The adhesion resembles a membrane of skin, similar to cellophane, creating a thin line where the skin meets.
Available Treatments for Adhesions
While most cases of vaginal adhesions are asymptomatic, the adhesions may cause some young patients to suffer from frequent vaginal infections, generalized genital pain, and difficulty urinating. Frequently, these girls also present with other vaginal or urinary tract disorders, including an imperforate hymen – a hymen that is solid rather than perforated as usual. The perforations in the hymen allow blood to flow out of the vagina during menstruation. A solid hymen membrane causes obstruction of vaginal flow, increasing the risk for a number of other problems.
Application of Estrogen Cream
When the adhesion occludes a large amount or the entire vaginal opening, the application of estrogen cream is indicated. The cream is typically applied twice per day for two weeks and once per day thereafter for a week or two. The likelihood of recurrence is high for the newly separated labia. To avoid re-adhesion, caregivers should take special care of vulvar skin according to the advice of the child’s pediatrician. The use of petroleum jelly on the newly separated labia may help prevent relapse as will judicious use of dye-free underwear and scent-free soaps and toilet paper.
Side effects from the use of estrogen cream are usually minor and include pigmentation of the vulvar area and breast development. These are completely reversible upon cessation of treatment.
Surgical Separation of Labia
Patients who are unresponsive to estrogen cream may be candidates for surgical separation. The surgery is performed under general anesthesia. Physicians usually prescribe estrogen cream and petroleum jelly post surgery as well as offering skin care guidelines to facilitate maintenance of separation. Many times, the adhesions recur because caregivers did not follow physician protocols consistently or properly.
Concern Without Hysteria
Noticing this kind of problem in a young girl can frighten parents, but the condition rarely presents any health issues that should cause deep concern. Parents should talk frankly with their daughter’s pediatrician about treatment options, prognosis, and other concerns.