Labial Agglutination Research Articles

A Rare Case of Vaginal Agglutination in Reproductive Age Group

Labia minora partial or total adhesion is known as labial agglutination. It commonly occurs in postmenopausal or prepubertal women and is accompanied by low oestrogen levels. Due to the high levels of oestrogen in women in the reproductive age group, labial agglutination is uncommon. Due to its uncommon presentation and a unique approach to treatment in this age group, where the patient has been suffering from infancy, we are presenting a case of labial agglutination in a female who is 22 years old. After a comprehensive clinical examination, extensive history-taking and all necessary laboratory and imaging tests, we were able to make the right diagnosis, which was then treated with expert surgery. Her abnormal vestibular structure was treated with this method without any complications. Patient was treated by surgery i.e. labial adhesiolysis under vaginoscopic approach using our standard hysteroscope light and camera. Labial adhesion can be treated both medically and surgically however treatment is individualized in every case ranging from medical treatment to minimally invasive surgery or invasive skillful surgery.

Labial Agglutination in Different Age Groups: A Case Series

Labial adhesion or agglutination is varying degree of apposition between the labia minora which may be complete or partial. Here, a case series of five patients of different age groups ranging from toddler, prepubertal, postpartum and postmenopausal age groups were included. Most often, labial adhesions are encountered in prepubertal age group due to hypoestrogenic state. Parents most often diagnose incidentally while changing diapers. Similar hypoestrogenic environment encountered in postmenopausal state where in addition to apposition, women have co-existent genitourinary symptoms for which they seek care. Old people may be delayed in seeking care due to uncertainty. Labial adhesions among reproductive age group are quite rare. Most of the case has a past history of trauma which was not adequately managed and the agglutination developed as a remote complication. All the five patients were managed as per the severity of adhesions. Treatment included from conservative approach of oestrogen cream application to surgical adhesiolysis.

Mycophenolate mofetil versus methotrexate for vulvar lichen planus: A 10-year retrospective cohort study demonstrates comparable efficacy and tolerability

Mycophenolate mofetil versus methotrexate for vulvar lichen planus: A 10-year retrospective cohort study demonstrates comparable efficacy and tolerability

Tubo-Ovarian Abscess in a Virginal Adolescent With Labial Agglutination due to Lichen Sclerosus

Lichen sclerosus is a chronic inflammatory disease affecting primarily the anogenital region and may cause symptomatic labial agglutination. We describe an unusual presentation of this condition in a postmenarchal, virginal girl. A 14 year-old girl presented to the Emergency Department of a tertiary children's hospital with acute urinary retention. A perineal inspection revealed labial fusion starting anteriorly and covering up almost two third of the introitus (Figure 1A). Because she was able to void during the assessment period in the Emergency Department, her labial adhesions were managed conservatively with topical estrogen and sitz baths. Ten days after initial presentation, she developed acute onset abdominal pain with fever. Abdominal ultrasound and magnetic resonance imaging revealed tubo-ovarian abscesses mainly in the right ovary and both fallopian tubes (Figure 2A and 2B). The patient was admitted to the hospital and started on intravenous antibiotherapy according to recommendations of infectious diseases specialists. Since adequate clinical response was not achieved with optimal medical treatment, drainage of bilateral tubo-ovarian abscesses was done by the interventional radiology under general anesthesia. In the same session, a simple division of the labial agglutination and vulvar biopsies were performed by the pediatric and adolescent gynecology team with a preliminary diagnosis of vulvar lichen sclerosus based on the clinical features of the patient (Figure 1B). Pathology, although not conclusive, supported the clinical impression. During her inpatient follow up, a second imaging-guided abscess drainage was required, four days after the first procedure, due to insufficient clinical improvement and residual right tubo-ovarian abscess detected on repeated abdominal magnetic resonance. After 3 weeks of intravenous antibiotherapy, the patient was discharged with oral antibiotics and clobetasol propionate 0.05% ointment for local treatment of the lichen sclerosus. The outpatient follow up has gone uneventfully and no recurrence of labial agglutination has been observed. The proposed mechanism for this rare complication of vulvar lichen sclerosus is vaginal pooling of urine due to significant labial agglutination, leading to ascending infection, pelvic inflammatory disease and tubo-ovarian abscesses. In conclusion, vulvar lichen sclerosus should be considered in cases of labial agglutination with atypical findings such as older age and anterior location. Finally, this rare presentation of vulvar lichen sclerosus reminds us that pelvic inflammatory disease and tubo-ovarian abscess must be kept in mind in the presence of fever, abdominal pain and adnexal mass, even in virginal adolescents. The existence of obstructive lesions of the genital tract should further increase the suspicion for these infections.Figure 2A and B. Pelvic MRI showing the tubo-ovarian abscessesView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Estrogen vs. Conservative Therapy for Labial Agglutination in Prepubertal Girls

The purpose of this study was to assess patient demographics, clinical presentation, and success rate in response to conservative management or estrogen treatment in prepubertal girls referred to a tertiary care center with a diagnosis of labial agglutination. A retrospective chart review was performed in all girls with labial agglutination treated at a pediatric and adolescent gynecology clinic between 2004 – 2014. Data was collected on the demographics of patients, severity of the labial agglutination, presenting symptomatology, type and length of treatment, and time to resolution (if any) of the labial adhesion. 435 patients were identified that met study criteria. One hundred charts of patients with treatment intervention and 100 charts of those with conservative treatment were reviewed to date. The treatment group received topical estrogen in the form of conjugated equine estrogen. Estrogen was prescribed in a variable manner at the discretion of the physician. Duration of treatment varied from “as needed” to 3 months. The other group received conservative therapy, more specifically education regarding vulvar hygiene. To date, 200 patients have been reviewed, 100 of which who were given topical estrogen therapy and 100 who were treated conservatively. Of those who were given topical estrogen, the mean age of patients was 3.9 years (range: 7 months to 12 years) as compared to 3.1 years (range: 7 months to 8 years) in the conservative group. 39% of the treatment group was symptomatic with irritation, redness, or urinary symptoms, compared to 20% of the conservative group. Severe labial agglutination was defined as greater than two-thirds fused and was seen in 67% of the treatment group, compared to 38% of the conservative group. 79/100 of the estrogen treatment group was followed after their initial consult as compared to 26/100 of the girls with conservative treatment. 35 patients with no treatment were discharged after the first visit and the rest were lost to follow-up. The median time the patients were followed in the clinic was 167 days for those with estrogen therapy and 105 days for those without therapy. Thirty-two patients (40%) in the estrogen arm had complete resolution of their labial agglutination and another 32 patients (40%) experienced improvements of their labial agglutination. The rest of the cohort (15/79) did not experience any improvement. With respect to the conservative treatment group, 9 out of the 26 that were followed experienced complete resolution (35%) and 11 (42%) had some improvements. The remaining 6 patients (23%) did not see any improvement. Labial agglutination is a relatively common condition in prepubescent girls. The guidelines for managing patients remain unclear. In this retrospective analysis patients who are more severely fused and symptomatic tended to receive estrogen therapy. Interestingly, the resolution rate and improvement rates of both treatment and no treatment to date appear comparable. Once full data collection has been completed, our intention is to use appropriate statistics to further compare variables between the cohorts of patients who received treatment vs. those who received conservative management only.

Clinical Recommendation: Labial Adhesions

Labial adhesions, also known as labial agglutination, are a common finding in prepubertal adolescents. They are defined as fusion of the labia minora in the midline or are termed vulvar adhesions when they occur below the labia minora (inner labia). Patients are often asymptomatic but might present with genitourinary complaints. The decision for treatment is based on symptoms. The mainstay of treatment in asymptomatic patients is conservative, with careful attention to vulvar hygiene and reassurance to parents. In symptomatic patients, topical treatment with estrogen and/or steroid cream is often curative. Less often, corrective surgery is necessary. Recurrence is common until a patient goes through puberty. These recommendations are intended for pediatric and gynecologic health care providers who care for pediatric and adolescent girls to facilitate diagnosis and treatment.

Severe Labial Agglutination Release in a Postmenopausal Woman

Labial agglutination occurs when the labia minora have become fused in the midline through either filmy or dense adhesions, forming a raphe. This condition is typically seen in pre-pubertal girls; however, there have been cases reported in the literature of labial agglutination in postmenopausal and reproductive aged women. Labial agglutination has been associated with local irritation and inflammation in the setting of a hypoestrogenic state. Topical treatment is usually recommended prior to manual separation. However, some postmenopausal women have been refractory to conservative management, and surgery may then be required. We present a case of a 79-year-old Caucasian gravida 3 para 3 who was referred for treatment refractory labial agglutination for 3 years. The patient’s complaints included a small trickle escaping from the introitus during urination and the sensation of little urinary control. The patient underwent an exam under anesthesia. Gentle blunt dissection with a lacrimal dilator easily separated the labia minora down the visible midline fusion line (raphe). Bimanual exam then revealed a 12-week-sized enlarged uterus confirmed on ultrasound to be an 8 × 8 × 7 cm irregular mass concerning for uterine cancer. Proceeding to an operative release of severe labial agglutination can relieve patient discomfort and frustration when estradiol therapy has failed. In addition to alleviating symptoms, releasing labial agglutination can also provide the gynecologist access to critical screening procedures such as cervical cytology or a bimanual exam, all of which could lead to a diagnosis or pre-cancerous or cancerous lesions.

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 Agglutination (Adhesion) in Pre-Pubertal Girls. What a Primary Care Physician Should Know?

The purpose of the study is to describe the clinical presentation and management of labial agglutination in prepubertal girls who presented to the paediatric endocrine clinic between January 2011 and June 2012. Five subjects were identified. Their age ranged between 6 months and four years (mean age was 2 year and six months). All patients were discovered by their parents incidentally while changing the diapers. Three of them were treated for severe diaper rash, while in one, the mother tend to use hot olive oil as emollient for skin protection. Physical examination showed various degrees of occlusion with no urinary symptoms. All were treated topically with oestrogen and one had recurrence.

Bladder outlet obstruction due to labial agglutination

Here, we report the case of a 63-year-old female patient who presented with emptying symptoms and was subsequently diagnosed with delayed labial agglutination. The adhered labia minora were divided by blunt dissection, and a topical estrogen ointment was applied after surgery. The patient’s voiding symptoms were completely resolved and no recurrence of labial agglutination was noted 3 months after surgery. Labial agglutination is rare but often manifests with nonspecific emptying symptoms. Nevertheless, it can be easily diagnosed on physical examination and successfully treated by surgical intervention and the application of a local estrogen ointment. We present this rare case in order to emphasize the importance of physical examination.

Urinary incontinence secondary to severe labial agglutination

The purpose of the study was to describe the presentation and management of urinary incontinence because of severe labial adhesions. Records of all patients diagnosed with labial agglutination and urinary incontinence at the Division of Gynecologic Specialties between January 1999 and February 2006 were reviewed. Clinical presentation, management, and treatment outcome were extracted from the records. Five subjects were identified. Mean age was 78 (range 59-87) years. Four subjects presented with mixed and one with urge urinary incontinence. Four reported change in flow of stream with voiding. Physical examination showed near-total occlusion of the introitus and urethral meatus in four subjects and partial occlusion in one subject. All were treated topically with estrogen and/or steroids. None of the subjects improved with conservative management, and all required lysis of the labial adhesions. Postoperatively, all were treated with daily topical estrogen and three with concurrent topical steroids. All subjects reported resolution of voiding dysfunction; three had complete resolution of their incontinence. Lysis of labial adhesions combined with postoperative topical estrogen and steroids appears to be an effective treatment in women with this condition.

Nontreatment Best Option for Most Labial Agglutination

Nontreatment Best Option for Most Labial Agglutination

Most Pediatric Labial Agglutination Will Resolve Without Treatment

Most Pediatric Labial Agglutination Will Resolve Without Treatment

Estrogen Treatment Success in Recurrent and Persistent Labial Agglutination

Study Objective To estimate the success rate of conservative medical management and indications for surgery in cases of recurrent and/or persistent labial agglutination. Design A retrospective chart review was performed of girls treated for labial agglutination between 1996 and 2004. Records were reviewed for age, length of time of symptoms, previous treatments, results of topical estrogen therapy, and indications for surgery. Setting The study was performed in a tertiary care teaching university hospital. Participants Charts of 67 girls with labial agglutination who were treated at the pediatric and adolescent gynecology clinic between 1996 and 2004 were reviewed. The average age was 4.1 years (range 0.6–14 years). Interventions None. Main Outcome Measures Improvement of persistent or recurrent agglutination labial agglutination with estrogen. Results Out of the 67 charts reviewed, 48 had recurrent or persistent disease. Within those 48 girls, initial treatments included: topical estrogen in 40 (83%), oral and topical estrogen in 1 (2%), topical estrogen in addition to manual separation in 5 (10%), and treated with manual separation alone in 2 (4%). Five girls were immediately treated surgically due to urinary problems or parents declining further topical treatment. Forty-three were treated with topical estrogen therapy with the following results: 15 opened either partially or completely, 9 required surgery, and 19 did not follow up. In the subset of girls with prior manual separation, 2 had resolution of adhesions with estrogen, 3 required surgery, and 2 had no follow-up. Conclusion This study suggests that re-treatment of persistent or recurrent labial agglutination with topical estrogen therapy following detailed application instruction leads to avoidance of surgical intervention in at least 35% of cases. Even in cases which previously required manual separation, an attempt at conservative medical management may be considered.

Coalescence des petites lèvres : faut-il la traiter ?

Labial agglutination is a common, asymptomatic and benign finding, among young girls. Whether the separation of labial adhesions is done with or without the use of anesthetic crems, with or without the use of estrogen, or during general anesthesia, it remains always a useless intervention, traumatizing for the child and with a great recurrence. Labial agglutination always regress spontaneously during the childhood, or at latest at the occurrence of first vulvar modifications which accompagnie the beginning of puberty.

Labial Agglutination in a Teenager

The patient is a 14-year-old girl, who presented for evaluation of labial agglutination. Her history starts three years ago when she was diagnosed with acute nonlymphocytic leukemia. She was initially treated with chemotherapy, but after a relapse she underwent radiation and a nonrelated bone marrow transplant. She was diagnosed with premature ovarian failure and has been on hormonal supplementation since age 13. She has developed graft-vs-host disease, which includes her eye, skin rashes, and mucosal changes. She has had one very light period in the last six months. She cannot use tampons. Her medications include Premarin, Cellcept, Macrodantin, and Tacrolimus.

Prepubertal labial adhesions: Evaluation of a referral population

Objective: The purpose of this study was to assess patient demographics, clinical presentation, response to previous treatment, and current evaluation of prepubertal girls referred for gynecologic care of labial agglutination. Study Design: A retrospective chart review of all prepubertal female patients with labial agglutination referred from 1996 through 2001. Results: Twenty-three girls were diagnosed with labial agglutination during the review period. All of the diagnoses were made by a primary care provider. At the time of referral, most patients had received medical therapy, but had not obtained resolution of their labial agglutination with topical estrogen. Twenty-two of the 23 patients required manual separation of the labial adhesions. Findings most frequently revealed a pinpoint opening and thick (3-4 mm) adhesions with >90% of the vestibule adhesed in 21 of 23 girls. Nine of 23 girls had recurrence of adhesions. Four girls required a repeat manual separation because of recurrent thick adhesions. One of 4 girls required a third manual separation. Five of the 9 recurrences were treated successfully with topical estrogen. Conclusion: Gynecologists who treat patients with labial agglutination frequently may encounter children for whom medical treatment has failed. Patients whose condition does not respond to topical therapy may have thick adhesions and require manual separation. (Am J Obstet Gynecol 2002;187:327-32.)

Prepubertal Labial Adhesions Might Require Surgical Treatment

Prepubertal labial adhesions (sometimes known as labial agglutination) are uncommon, but they can be symptomatic. The cause of labial adhesions is uncertain, although conditions that irritate the vulva (e.g., recurrent diarrhea) might be responsible. This retrospective chart analysis was conducted …

Labial agglutination in girls: reasons for failure of estrogen therapy.

Objective: Labial agglutination is a common vulvar problem in children. Topical estrogen is generally first line therapy with surgical separation reserved for those cases that do not respond and have significant adhesions or urinary symptoms. The objective of this study is to review cases of labial agglutination treated at our institution and determine the causes for failures of estrogen therapy requiring surgical intervention.

Three decades of acquired gynaetresia in Ibadan: clinical presentation and management

A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively.The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Read's two stage vaginplasty, separation of labial agglutination, Williams's operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.