The Truth About Labial Adhesions
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What Are Labial Adhesions?
No one seems to talk about this one, but Labial Adhesions are a common occurrence in little girls. It's when the inner vaginal lips (labia minora) fuse together appearing to close off the opening to the vagina. It's thought to occur in 1-2% of girls aged 3 months to 6 years.
A parent may notice labial adhesion, but they usually cause no symptoms and are noticed only at a routine well-child checkup with a pediatrician. They are easy to treat, if they need to be treated, but the doctor may want to rule out any other vaginal disorders before treatment.
What Causes Labial Adhesions?
Experts aren't 100% sure what causes labial adhesions, but most agree they are caused when the labia become irritated or inflamed, as could be the case in a wet diaper. When the raw skin heals, it creates tissue that fuses the labia together. Soap residue on clothing may play a part as well as low levels of estrogen, which is normal before puberty. They may be the result of sexual abuse, but this is certainly not the reason for the majority of cases.
Labial adhesions can cause blockage of the urinary tract. A child may also complain of ‘drips' or parents may notice urine-stained underwear. Even if the adhesions are not fully blocking the urethra, a pocket of skin may form, trapping small amounts of urine, which are released when the child stands.
Bladder infections may be more common in girls with labial adhesions. Urine trapped in the extra tissue may make it's way back up into the urethra cuasing infection.
If you want to see a picture of what it looks like in a baby, there is one at the bottom of this page:
Effects of Estrogen Cream
It's important to note that estrogen cream can have side effects. Girls and even infants may show some minor breast development during estrogen treatment. The skin around the labia and/or nipples may darken. Stopping estrogen may even cause vaginal bleeding, but this should be very minimal and not a cause for concern. These symptoms usually subside after estrogen treatment is stopped and most girls will use estrogen without any side effects.
Treatment
Some doctors like to treat labial adhesions, while others believe that left untreated they most like will resolve on their own at puberty.
Treatment usually consists of the application of topical estrogen cream to the affected area. This causes the tissue fusing the labia to dissolve, separating the labia. Once separate, antibiotic cream is used to promote healing.
If your doctor opts to treat your daughter's labial adhesions, don't be surprised if they separate, heal, then later return.
Always follow the advice of your pediatrician. Never try to separate the labia with force. It will hurt and traumatize the child and usually cause the adhesions to heal worse than they started. In rare cases, the labia may need to be surgically separated by a doctor.
Prevention of Recurrence
Good vulvar care includes avoidance of irritants. Keep diapers dry and use fragrance free detergents. Don't scrub, but clean the vulva daily with water. Stay away from the bubble bath! And teach your daughter to wipe from front to back. Let the area get some air every day. Apply a lubricant like petroleum jelly to the labia at night.
The main thing is to remember it's nothing you did wrong, and it's a very common occurrence - even if no one says so!
Common Sense Medical Disclaimer:
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Comments
I chose not to put a picture on this Hub. However, I did feel it was useful for those who wanted to know what the condition looks like to have that resource. Many girls suffer from urinary tract infections because of labial adhesions. The picture I linked to is on a medical website. I'm sorry that you were offended by the picture. I certainly didn't want to offend, which is why I did not post the picture, but only a link. If you don't want to view the photo, please do not click the link.
Thanks to you, i now realise that my young daughter probably has this condition. The photo link did help as all the rest i looked at on the internet showed adult women and not a child. It was easier to compare. I was not aware untill today of its symtoms (of which my daughter has told me she has had, over the course of time). My doctor did say to wait unitll puberty.
My daughter was born with this and starting at 4 or 6 months we started on the estrogen cream. There were no physical side effects and the adhesion opened up after about 4 weeks of using the cream every day. Once opened, we kept it from re-fusing with a touch of vaseline to the area. I had no idea this could happen when she was diagnosed, but I'm happy there was a quick resolve! Thanks for this informative Hub. - Blogger Mom
The biggest thing you need to watch for is that girls are not getting bladder infections, which are pure misery.
Very well written about this problem,concised and easy to follow for everone.
I disagree with the first responder: Thank you for the picture. It has helped me to determine what the doctor was talking about. Our pediatrician just diagnosed my daughter with this condition 2 days ago. I was mortified when he was explaining this condition. I've never heard of this - now I feel bad that I didn't prevent it. I was in such shock at the time he was explaining things that I didn't absorb everything he was saying. I've been doing online research to find out the causes and to see what all of our options are. Your article has been very informative.
You have provided us with an excellent advice and with a condition that I didn't know existed, I had 5 girls and I am happy to say that none of them developed that. Thank you for a well writen explaination, and I too disagree with the first responder, I see very well that your intentions where noble, and not "morbid". As a Mom, I didn't take offence as you only posted a link. Thank you again. Many moms feel guilty when their children develop some unknown problems, but this is not their fault!, it could happen to anyone's little girl.
My daughter is in her 30's and has 4 children, but when she was an infant the pediatrician did somthing while he was examining her genital area and she jumpped and then cried and he said, he fixed what could be a big problem for her when she grew up. I was very young at the time and didn't ask for details, but I trusted him completely - now I'm wondering if that isn't what he 'fixed' or was it something else?
Thanks for the support! We need to understand our bodies - they belong to us after all! Celebrate 10 Years of the Vagina Monologues
I have visited different sites for information on labia adhesion--my daughter was diagnosed at age 2 1/2--and she is now 4 years old. Initially, the area did open with the use of the topical cream, however, i am still battling this problem. It is starting to close again and she is always complaining that it 'hurts'..i continuously use vaseline on the area but am also frustrated--i don't know if she has any other infections--the doctor just looked at it and says it is fine--but I don't believe that. I am considering seeing a specialist.
Thank you for the article and most of all thanks for the link to e-Medicine: we are taking our daughter to the doctor because we think she has this condition and it was very helpful to see what it looks like. I completely disagree with the first comment. Plus, in order to post that picture on a medical website, the doctor would have had to have authorization from the parent. Thank you so much, this article really helped.
I found this site very helpful. My daughter had a stomach virus that caused a diaper rash and yeast infection. Her doctor gave her some cream a few days ago. Her rash has improved but then lastnight i noticed that her vagina was closing!! I was in comlete shock!! I had NEVER heard of this. Then I got upset b/c I didn't know what I did wrong I mean I bathe her and keep her clean. I talked to the doctor and he said that she was raw from the rash and that when it healed, her vagina healed together. . . no problem. I take her to the doctor today. It is just nice to know that this is normal and that it can happen to anybody...thanks for this site!!
Instead of petroleum and instead of antibiots use coconut oil unless allergy presents itself.
coconut oil is much more safe, natural, and inexpensive.
it might work instead of the estrogen cream also, don't know.
and coconut oil can be taken and is very helpful to take orally and to use as cooking oil. (instead of the toxic cooking oils sold in most grocery stores)
I just noticed that my 6 year old daughter has developed labial adhesions. The pediatrician is prescribing Premarin to be used. I was wondering if anyone has noticed if the child experiences any discomfort on the adhesions from the cream "thinning" the area and when it separates. I am also concerned with the possible breast enlargement because she is so much older than the norm. She is six and is very aware of her body and changes.
Any opinions or advice would be welcomed before I actually begin treatment on her.
After we noticed some complaining when she urinated, my 2.5 year old was diagnosed with labial adhesion, and her Dr. did prescribe premarin cream once a day at bedtime. I am just now noticing that it is starting to open up a little, after about three weeks of treatment. Also tonight we noticed her nipples are a little swollen, and I can feel little bumps underneath. This totally freaked me out. I guess I need some reassurance that this treatment will not hurt her, and it will go away once we stop treatment...yikes. I keep reading various articles, and of course I find contradicting info (one article said that estrogen cream should not be used for more that two weeks).
I have 3 girls and all 3 have had this problem. Two of them have been fine, but my middle daughter is 4 and we are just starting the cream. She is having a hard time keeping herself dry at school all day. At home she changes panties alot, and gets upset. Its only a "dribble", but it causes her to smell like she wet her pants. I pray this goes away for good after treatment this time!
Our old pediatrician discovered my daughter's labial adhesion on her first thorough check up. He suggester the estrogen cream, which scared me ( i didn't want to put hormones on my newborn) or said it may"fix itself over time with normal activities". I opted for that course. It has not "fixed itself" and my daughter is almost ten now. What are my options at this point. I don't want to traumatize her by some big procedure or embarass her by having doctors spending too much time in her private area. Any help would be greatly appreciated. P.S. She has had NO problems due to the adhesion up to this point. I simply don't want to wait until she matures and it DOES become a problem.
Hello! I didn't know treatment with cream was an option. My daughter had this and the urologist performed surgery. I wish I would have tried cream first!
My 16 month old developed this and we have no health insurance I was very comforted to know that this isn't something I need to rush her to the Doctor for!
Hello and thank you for this article. My 16 month old has been diagnosed with this... about five or six months ago. At first we were to just massage the area with A & D ointment but that didn't work so now we are using Premarin. Today is the first day but the doctor said it should take up to 3 weeks to work. If this doesnt' work than she will have to be sedated and have it slit open.. =( Here's hoping that the Premarin works. My 6 y/o had the same condition when she was an infant/toddler but hers opened up on it's own.
Thank you for posting this. I just noticed this on my 19 month old daughter and thought something was seriously wrong with her. I was bawling freaking out!! i hated to actually look for pics to make sure thats what it was but pics did help even though it did feel wrong. it is necessary though and i doubt any child molester/pervert will be checking medical websites to get their kicks. she is starting estrogen cream tomorrow.
My daughter was diagnosed. I used Premarin for 10 days. It went away. I check routinely and when it came back, I did use my fingers to separate it. It separated very easily and my daughter seems fine, but now I am really concerned I hurt her. I just did this today. Please tell me what to do to be sure I did not hurt her.
My daughter was diagnosed when she was 3 months old, she is now 7 years old and is still sealed. The doctors I have talked to want to wait till she hits puberty. It doesn't bother her at all but I still do research to see if there is any new ideas out there. It helps to read I'm not the only one going through this and there are others that understand the situation.
Ladies, you are definitely not alone! This is a very common issue in girls. Most likely there is absolutely nothing to worry about and whatever your doctor recommends is the right thing to do. You are correct though, that there are different opinions about when and if something needs to be done, or if it can be left alone to clear up beore puberty on its own. Talk to your doctor and get a second opinion if it makes you feel better. Also, most doctors' nurses are glad to discuss ongoing cases over phone if you have a particular concern.
My daughter is 5 yrs old. She has been on Premarin cream on and off since she was 3 months old! She has seen a specialist in Boston several times. (Today was the latest) This has reacured 10-12 times in 5 yrs. Every time the Premarin takes longer and longer to work. This time 11days twice a day and no differance. She dribbles after urinating. The Dr said she will have to "deal with it" till it goes away once she hits puberty! (the average is 12 yrs old) She is in school and I am afraid she will be picked on. We are taking her to another DR. Also I am worried about the long term use of a hormone cream.
Well-written article, Lela. Just wanted to add - others have said it, but it's so important, it's worth repeating - any parent who has any doubts whatsoever regarding the safety of a medicine should talk it over with her doctor or pharmacist. Just because a medicine is a 'hormone' doesn't necessarily make it dangerous. Likewise, just because a medicine isn't a hormone and you can buy it from the supermarket doesn't make it safe! Example: common cold products, even those made for kids, could well be more dangerous to a young child than the hormone cream.
A lot of the known dangers associated with estrogen use was discovered through studies on women who had taken estrogens (normally contraceptives) orally, often for several years. A cream is less likely to be absorbed into the blood, and would probably be absorbed in much lower amounts. Since this treatment is usually only necessary till the child hits puberty, the duration of treatment is also probably lower than what you would find in the main studies conducted on estrogen use (women on contraceptive pills likely would have taken them for a much longer duration). While it's true that long-term estrogen use is known to increase the risk for a number of diseases, it's also important to bear in mind that this is a relatively tiny, tiny risk compared to other more common and serious risk factors like smoking, obesity, unhealthy diet, sedentary lifestyle, genetics etc. Compared to all these other risk factors, the risk from estrogen use alone is not likely to be very significant. So it's important to maintain a sense of perspective when considering the risks of using estrogen creams.
A note on urinary tract infections: this is not only painful (for both mother and child!) - it's potentially dangerous. An untreated urinary tract infection can lead to infection of the kidneys and/or reproductive organs.
By the way, Lela, you did exactly the right thing in linking to the picture. As others have noted above, it was useful to illustrate the condition. You couldn't have posted the picture straight here in any case, since you don't own copyright for the picture and you did not receive permission from that child's parents to use her picture (unlike the people who originally took the picture - since you found it on a responsible and reputable website, they would likely have had the parents' permission for taking and using the photo in the first place). Anyone who suggests that you are promoting child abuse by linking to a medical website, where a picture is shown for medical education purposes, is simply wrong-headed.
Thank you for the article and the photo. My 2 girls never had this, but my granddaughter does, and it's the first time I've heard of it. She's 18 months now and on her 2nd treatment of Premarin. The 1st time was about 6 months ago, then it readhered. My concern is I'm not sure how much the area is to open up. There is a little circular hole/opening at the distal area and the labia is starting to part, but I am unsure how much it is supposed to open?
Thank you for this article. My little one was diagnosed w/ this condition from her 1st well baby check up, days after she was bourn. She will be 16 months tomorrow & the area has still not opened. Though, her Pedi doesn't seem to be worried I've had a nagging feeling somehow I caused this. Your article, as the many responses, have eased my worry. Again, thank you.
Thank you for this article, my daughter was complaining of pain and when diagnosed the docter explained us about this condition , and my wife was very much worried anou it .I can now happily show her this article and start with the treatment from tomorrow.
I am furiously searching for information on this topic. I just noticed this today on my 3 month old and am very concerned. I didn't even know it had a name. I appreciate everyone's feedback and testimonies. I will take all of this with me to her pediatrician tomorrow. I feel somewhat comforted in knowing that others have had experience with labial adhesions and there may be some effective means to treat it.
Thank you so much for the article. My daughter is almost 3 and we have been dealing with this off and on since her 3 month checkup. We are potty training and I haven't been as vigilant at checking the adhesion as I should have been and am now kicking myself because they are worse this time than last. So we are on the premarin again. This time is worse because she doesn't want me to put the cream on, so I have become the traumatizing mommy!! Usually takes about 2 weeks. I had never heard of this condition before I had her, but am glad to know it's fairly common. Good luck ladies!!! Also, glad to see the link for the photo. When they are little, it's hard to tell what you are looking at. It helped alot!!
My 2.5 year old daughter was also just diagnoised with this. She also got a urinary tract infection and the adhestions seem to have gotten worse now. I hope this corrects itself. We see the Dr. again next week.
My daughter is 5 yrs old and like many of the others we have been dealing with her fused labial since 6 months old. We have used premarin cream off and on since six months old. At first it worked fast to separate the adhesion, but it would always come back. Now the cream seems to not help at all even when used twice a day for two plus weeks. She is starting to grow pubic hair now.She only has a tiny opening left to the vaginal area. She complains of it hurting and she does have leaking from the urine pooling just above the fused area. She has not had a urinary tract infection so far even with the complaints. I keep reading that is ok to to wait until she hits puberty but I worry that she could get an infection in the future. I don't want her to go thru surgery if possible. I think we are going to use vaseline or a+d Oint from now on. I really think if the premarin was the solution for us it would have worked better by now. I am worried about the hormones too but was willing to try. I think we tried long enough. Your article was very helpful and the picture was also helpful to relate what I was seeing with my daughter. I was disappointed to read the first comment, obviously she does not understand how important the info is to families with concerns and questions.
its great to know your not alone ,weve been using the cream for about 4 weeks and no change but we shall wait and see
i find the first comment rather disturbing ,i looked up the subject because my daughter has one and was looking for something to compare with ,how did she stumble across it !
I just discovered that my 6 month old has this condition. I had never heard of it before and, like all of you, was quite upset about the whole thing. Reading all of your comments certainly helped to ease my mind. My doctor prescribed the estrogen cream which we started yesterday. She said "as soon as the labia opens it will be fine and stay open". However, now I'm concerned as it sounds like several of you have indicated that the condition can recur over and over!
My daughter has used cream 4x and already had two surgeries and we are still fighting the issue (she just turned 4). i have been researching the subject online as well, and found flaxseed oil was listed as a potential solution... at this point I am willing to try about anything. Also noticed that many references include a link between UTI & constipation... my daughter has sufferred from constipation since birth as well, and UTI's from the labial adhesions... am wondering if constipation may be a commonality for any of you as well - perhaps there is a link???
My daughter is now five and has had two surgeries around 1 1/2 yrs and at 3 trying to correct this problem, yet the problem persists... She was diagnosed and given premarin at around 3 months. The doctor changed her to estrace (stronger) when that didn't work and then referred her to the urologist.... 4 years later I want to say it's hard to put medicine, or lubrication on your child daily that changes their attitude and violates their personal space. I want to encourage my child to be comfortable with her body and that that is her private area. So for the last year or so, during bath time I ask her to pull her vagina open. Telling her it's important. If it closes all the way ladies, these kids are going to have serious problems! After bath time she sits on the toilet and opens her legs and puts a little KY on her finger and then her little afflicted spot to lubricate. I feel KY is better than Vaseline (I was told I could use either by the urinologist).
BTW she has always had constipation.
There is no way I'm giving her any MORE hormones. I think there is nothing wrong with trying the hormones, but don't just keep applying them. If it's not working STOP. My five hear old is VERY moody and her nipple area is pooky. The side effects DON'T stop when you stop applying. I gave her the premarin and estrace for like 6 months straight when she was a baby following the pediatricans script to use it until it clears up. I will always wish I hadn't!
My plan is to keep having her lubricate and pull daily until puberty. After puberty and early check with obgyn will probably check with surgery again, maybe some kind of vaginal reconstruction.
Are there any grown girls or women who have had this that can give advise? I worry that intimacy will be uncomfortable when she is grown, unless there is drastic change naturally or we have another surgery. However, with 2 surgeries already and the same problem persisting, I think the wait and see approach is good now until puberty.
These are all good articles.My daughter was dignosed at 18 mo. Then she's been on Estrance since then she's 2 1/2 now. No change. I've breastfed her and just wonder if that had a part in this with low estrogen. Don't know Dr.'s don't seem to know much or even feel concerned. I have noticed a big change in her moods w/the cream. She' like an emotional roller coaster. Has anyone noticed this? She's is suppose to have surg. but is there anyone who has had pos.results with surg.? This is hard because you really feel alone and helpless for your child. I wish I had a quick fix. It does help a little to finally hear some similar stories.
I had this when I was young. I'm now 29 and have had no problems since I was 7 or 8. No side effects in later life either (intercourse,etc.) My mom didn't use the cream. I went to a specialist who told my mom to watch closely and pull slightly each day and I think he also worked with me that day showing her how to pull. My daughter is 2 1/2 and has this and I'm trying to decide what to do. She does seem to be bothered by it, but hasn't had a UTI. I don't want to use the cream and I plan to check for other natural options. Has anyone tried the coconut oil or flaxseed oil?
Thank you for posting this. I was told today my daughter didn't have a vaginal opening, and to use estrogen cream to open the adhesion. I didn't really understand, nor had I ever heard of the condition. I didn't ask questions because I was freaking out! (I had noticed it, but I was hoping I was wrong!) I am glad you posted the link for a picture, it made me feel better to recognize it in my own daughter. I am going to make sure I ask more questions next time though, I feel silly (and so should my doctor) that I didn't understand until I looked it up on the internet! What did mom's do before the web???
My 2 1/2 year old just had the surg. to separate the adhesions yesterday 11/4/09. she's okay a little tender. It looks good after seeing it almost closed for so long they put her on Premarin cream for a few weeks.
My daughter is five and was diagnosed with Libial adhession today, I feel terrible because she would complain about itchness and irritation, I thought she was not cleaning herself when she used the potty!! One other thing I'm shocked to see is that most of these girls have also suffered from chronic constipation (I would have never tied these two together), my daughter too has always had issues with constipation and a hard stool! There has to be more to this then what doctors say! They told me she had an adhession when she was younger but told me it was no big deal and that it would go away along with the constipation and brushed it off as being normal!! This makes me really upset one at the doctors and two at myself for not rearching and asking questions! She was given an estrogen cream that Im suppose to apply daily but other then that the doctor said it was no big deal!!! There has to be more research done on this!!
DebbieCookie says:
2 years ago
I dislike the act of the person responsible of adding such picture of that innocent little baby encolse - using her ,exploiting childrens without a voice by exposing her private body part to show examples of Labial Adhesions in a child.That is a big NO NO. Grow up people ,Since she does not have a voice I am here to stand up for her and complaining about this in her defense.Things like This can only be convinient to sexual predators out there,is it that you are one of them and with this your supporting there crimes.Do you know your doing the same thing?OPen your eyes and protect the child.You could ve use a drawing as example not an child .That is so unacceptable and very offensive to me and I am sure for other mother and people that care. Stop crime like this dumb ass .