Complete Labial Fusion Research Articles

Labial Fusion in a Postmenopausal Woman Presenting with Urinary Incontinence

ABSTRACT Genitourinary syndrome of menopause refers to the collection of signs and symptoms associated with decrease in estrogen and other sex steroids involving changes in labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. This term was coined in 2014 to reduce the stigma associated with genital symptoms after menopause. Our patient is a 65-year-old woman, menopausal for the past 15 years, who presented with dribbling of urine for 1 month. On examination, she was diagnosed with complete labial fusion. Diabetes was incidentally detected and antidiabetic treatment was started. Considering dense labial adhesion, the patient underwent surgical separation of labia under anesthesia. Postoperatively, she was put on topical estrogen therapy and was advised to maintain proper hygiene. She was followed up regularly for a month to prevent refusion.

Chronic Bladder Retention Due to Lip Coalescence: A Case Report

Coalescence of the labia minora is defined as partial or complete adhesion of the labia minora. Complete labial fusion is a rare condition in adults. Coalescence of the labia minora generally occurs in early childhood and in prepubertal girls. It is a rare entity in women of childbearing age, except in cases of hypo oestrogenism. In general, micturition dysfunction is a rare complication of labia minora coalescence. We report the case of an 18-year-old female with complete and severe labia minora coalescence complicated by bladder retention.

Complete Labial Fusion in Postmenopause

Labial adhesion is defined as flimsy or dense fusion of labia minora in the middle which may be congenital or acquired. These adhesions are usually seen in prepubertal girls but rarely in postmenopausal women. Management options include topical estrogen with or without steroids or surgery in persistent circumstances. The case reported here was an 83-year-old postmenopausal woman who was presented with urinary retention and recurrent urinary tract infections. On examination, she had complete labial fusion leaving only a pinhole opening for voiding. A surgical approach was performed via a midline incision and complete excision of bilateral labia minora. Her urinary complaints were dissolved. Surgical management options for postmenopausal complete labial fusion cases will be discussed.

Acute urinary retention due to complete labial fusion in the postmenopausal period: A case report and literature review

Klinigimizin acil servisine, ani baslayan idrar yapamama ve kasik agrisi sikayeti ile 74 yasinda bir hasta basvurdu. Hastanin genel fizik muayenesi normaldi ancak yapilan dis genital sistem muayenesinde komplet labial fuzyon tespit edildi. Labial fuzyon, labium minuslarin birbirine tam ya da kismi olarak yapismasi olarak tanimlanan bir durumdur ve genellikle prepubertal donemde gorulmektedir. Postmenapozal donemde ise cok nadir olarak gelismektedir. Genel anestezi altinda acil olarak cerrahi islem uygulanan hastanin operasyon sonrasi sikayetleri kayboldu. Komplet labial fuzyon, kadin hayatinin hangi doneminde olursa olsun genellikle, idrar tutamama ve idrarini bosaltma fonksiyonunda bozukluk bulgulari ile kendini gosterir. Literatur arastirmamiz ve kendi olgumuz gostermektedir ki; postmenapozal donemde ortaya cikan labial fuzyon prepubertal donemin aksine, genellikle medikal tedaviye direnclidir. Boyle olgulara cerrahi islem uygulandiginda dramatik bir sekilde iyilesme olmaktadir.

Complete Labial Fusion in a Postmenopausal Woman Presenting with Retention of Urine

Complete labial fusion with retention of urine is a rare clinical entity. It occurs when the labia are fused in midline, forming a raphe. It usually develops in postmenopausal women with hypoestrogenism. The usual treatment is with topical estrogen and surgical separation followed by some dilatation. Here we present a case of a 58 years’ postmenopausal,unmarried, nullipara woman who came to our emergency ward with retention of urine.She had history of incomplete voiding and dribbling of urine since six months. General examination and investigations were normal. Her clitoris was normal in size, and the labia majora and anus were visualized well; however, the urethral meatus and vagina were not seen because of fused labia minora.Patient required surgical excision of fused labial folds to relieve the retention.Keywords: Labial fusion; postmenopausal; urinary retention.

Advanced Lichen Sclerosus Resulting in Complete Labial Fusion and Urinary Retention in a Postmenopausal Patient

Advanced Lichen Sclerosus Resulting in Complete Labial Fusion and Urinary Retention in a Postmenopausal Patient

The effect of chronic vulvar dystrophy on urinary continence in patients at climacterium

Chronic dystrophy is the growth of abnormal skin on the vulva, its causes being lichen sclerosus, with thin vulvar skin lesions and squamous hyperplasia with thick tegument. Lichen appears as discolored, translucent irregular areas of skin on/around the labia especially in women at climacterium. It can cause from lack of clinical manifestations to intense itching and progressive vulvar pain. Squamous hyperplasia transforms vulvar skin thick with white elevations causing intense itching. We examined a number of 22 climacteric patients, aged between 52 and 73 diagnosed with vulvar dystrophy in the interval 2014–2016. Urinary incontinence was diagnosed in 90% of them: 36% presented stress urinary incontinence, 40% mixed incontinence (vulvar dystrophy being a factor in the continence impairment), while in 22% of the cases the main etiology of the disease was the severe alteration of the vulvar anatomy. The 5 cases presenting important distortion of the external genital organ anatomy included partial labial adhesion or complete labial fusion caused by chronic dystrophy and required surgical intervention. The etiology in the appearance of labial adherences is thought to be inflammation of the labia with denudation of the superficial layer which heals by fibrosis causing adhesions. Labial fusion in menopause is a rare condition which in addition to chronic dystrophy has other two risk factors: relative hyperandrogenism associated with lack of estrogens and chronic urinary tract infections (UTI). Regarding recurrent UTIs, they represent both a risk factor and a consequence of labial fusion, the urine dribbling through the labial adherence over the external urethral orifice and draining through the vagina. Labial fusion affecting urinary continence is an uncommon phenomenon in postmenopausal women. The prognosis is good with surgical treatment, while estrogen and corticosteroid topic application should be used as prophylaxis for recurrence.

AB079. Phenotype variation in untreated 46,XX congenital adrenal hyperplasia

Simple virilizing congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder characterized by 21 hydroxylase deficiency leading to excessive androgen production. In infants with 46,XX karyotype, prenatal exposure of androgen overproduction leads to a gradual virilization of the external genital. Consequently, babies are born with an ambiguous genital which complicates sex assignment. Genital virilization will be progressive if these babies remain untreated. In country where newborn screening is available, patients with CAH are identified soon after birth and receive medication afterward, unlike in Indonesia. Many parents and patients with CAH did not seek healthcare professionals due to lack of information about inheritance and clinical manifestation of CAH. In Indonesia, newborn screening has not been applied yet; management and therapy for CAH are only available in some big cities but glucocorticoid medications need to be imported. Diagnosis was established using karyotype, hormonal and gene mutation analysis. In this study, we reported 30 patients with different physical appearance i.e., big phallus, one or two ending perineum, very severe chordae, labioscrotal fusion, complete labial fusion with scrotalization, masculization, no breast development, severe hyperpigmentation, appears Adam’s apple and short stature. Sex assignment is still a dilemma; some of the children were raised as males, females, or left undefined. The complex management of children and adults with CAH highlights the importance of raising awareness among medical personnels to promote early detection and treatment for CAH patients. Genetic counseling is essential for these families.

Complete Labial Fusion With Vaginal Constriction Band Presenting as Incomplete Voiding

Labial adhesions are most commonly described in prepubertal girls. Only a few cases have been reported in postmenopausal women presenting with incomplete voiding. This report describes a case of a 51-year-old postmenopausal woman who presented with incomplete voiding and urinary incontinence. On examination, she had complete labial fusion and intraoperative findings of distal vaginal stenosis due to a constriction band. The patient was surgically treated with lysis of the labial fusion, posterior vaginal advancement flap with complete resolution of her urinary symptoms. In this report, we present a case of a postmenopausal patient with complete labial fusion, distal vaginal stenosis, and incomplete voiding who underwent successful surgical management with good anatomical results and complete resolution of urinary symptoms.

Novel presentation of labial synechiae: two urinary streams.

Labial synechiae, also referred to as labial adhesion or labial agglutination, is a disorder of the female genitalia characterized by thin, membranous adherence of the labia minora. Typically, the fusion originates from the posterior fourchette and advances toward the clitoris. Complete labial fusion may conceal the vaginal introitus completely. Partial labial fusion is also possible and may occur near the posterior fourchette.

Labial fusion causing urinary incontinence and recurrent urinary tract infection in a postmenopausal female: a case report

A 73-year-old postmenopausal woman was admitted with recurrent urinary tract infection and a history of incontinence. General physical examination was normal. Complete labial fusion was noticed on genital examination. Surgical intervention was performed. This therapy alleviated incontinence and recurrent urinary tract infection.

Labial fusion in the reproductive age group: a rare presentation

Labial fusion is a common condition in prepubertal girls due to hypoestrogenism or in postmenopausal women with lichen sclerosis. It can also be seen as a result of chronic inflammation, urinary tract infection, and sexual abuse or following female genital mutilation. We present a rare case of almost complete labial fusion in a woman of the reproductive age group without any identifiable cause.

Labial fusion causing upper urinary tract obstruction

An infant with dense and nearly complete labial fusion had marked hydroureteronephrosis which resolved after incision of the adherent labia. Although this is an unusual consequence of labial fusion, it argues for upper urinary tract screening in these children.

Embryotoxicity of a single dose of medroxyprogesterone acetate (MPA) and maternal serum MPA concentrations in cynomolgus monkey (Macaca fascicularis)

A single dose of MPA (Depo-Provera; Upjohn Co., Kalamazoo, Michigan) was administered intramuscularly to 12 time-mated pregnant cynomolgus monkeys on day 27 (+/- 2) of gestation at 25 mg/kg or at 100 mg/kg. Maternal blood samples were collected immediately prior to MPA injection and then at regular intervals until cesarean section at term (day 152 +/- 3). Infants in both dose groups had external genital abnormalities. Female infants in the low-dose groups had partial or complete labial fusion, prominent median raphe, and clitoral hypertrophy; at high doses (100 mg/kg), the female infants had complete labial fusion and a distinct penile urethra. MPA had an opposite effect on external genitalia of male infants. The penis was short and the scrotal swelling was absent or less conspicuous, and two males had hypospadias. The adrenal glands were significantly smaller (P less than 0.05) in infants of both sexes treated with 100 mg/kg. One of the infants treated with 25 mg/kg of MPA had a muscular ventricular septal defect. Serum concentrations of MPA were determined by radioimmunoassay in eight pregnant monkeys. In the 25 mg/kg group the patterns of MPA profiles in the serum were similar in all four animals. An initial peak occurred at 24-48 hr postinjection (2.7-9.6 ng/ml), followed by a slight decrease at 3 days postinjection (gestational day 30), and then a steady increase to maximum levels of 10-14 ng/ml occurring between gestational days 37 and 50. Serum levels gradually declined to concentrations below 5 ng/ml by midgestation in three of four monkeys. By comparison, both the patterns and magnitude of MPA concentration showed great interanimal variation in the 100 mg/kg group. MPA was present in cord blood at measurable concentrations in infants at both dose groups; the levels ranged from 0.6 to 8.3 ng/ml, corresponding to 40-72% of the maternal concentrations. These results demonstrate that a single injection of MPA during early pregnancy causes selective embryotoxicity in both male and female fetuses. Presence of high levels of MPA in maternal sera during the critical period of genital development can cause specific genital defects; however, the exact mechanism by which MPA causes these paradoxical genital abnormalities is unknown.

Female circumcision: management of urinary complications.

Reviews 73 case records of female patients 55 girls and 18 adults with post-circumcision complications treated at the University of Nigeria Teaching Hospital in Enugu between 1973 and 1981. Lesions associated with urinary problems were the most common complication (28.8%) with complete labial fusion and meatal obstruction contributing to 57.2% and 23.8% respectively of the urinary complications. Urinary infection and urethral structure each accounted for 9.5% of patients. Diagnosis and management of the complications are discussed.