Labial adhesions: Facts and fiction

Abstract

Sir,Labial adhesions (vaginal synechiae) are a commonproblem encountered in general pediatric but there are alot of misconceptions regarding the etiology andmanagement. We had a similar case where a case of labialadhesion was misdiagnosed as case of vaginal agenesis. Athree-year-old girl was referred by local practitioner withcomplaints of absent vagina and burning micturition. Thechild also had dribbling of urine on standing up aftermicturition. The child was advised, apart from a urineroutine urine examination, a urine culture, anultrasonography of the pelvis and a micturatingcystourethrography to rule out genitourinaryabnormalities. On local examination the child was foundto have adhesion of the labia minora which lead to thecomplete closure of the introitus and child voided from asmall orfice at the posterior aspect of introitus near theposterior fourchette (Fig. 1). The urine culture was sterile.These adhesions were lysed in the out patient departmentusing a blunt artery forceps after local application of 5%lidocaine ointment and it revealed a normal urethral andvaginal orifices. The child started on a regimen ofestrogen cream application for three weeks. The child isasympomatic after three months of follow up with norecurrence.occur much later.