Lela Davidson is a mother and writer who is passionate about healthcare and education for women and children.
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. According to the doctors at Medscape, this disorder most often occurs in girls aged 3 months to 3 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.
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:
Just in case you wonder, I'm not a doctor or any other kind of medical expert. I am just an experienced mother. Information contained in this article is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor or pharmacist can provide you with advice on what is safe and effective for you or your child.
anakasha on August 13, 2012:
Hello, I have a daughter who is now 17. She had this as a baby. We used the cream. The only thing about the cream was it made her really sensitive and she would touch herself a lot. That is the only thing we had happen because of the cream. I stopped putting the cream on her once she was potty trained, but the cream stopped it from growing back together after the doctor opened it up. She didn't cry or get upset when the doctor opened it up and does not even remember it.
The problem now is that her opening is the size of a pencil and our doctor told me it needs to be opened surgically. She can not have sexual relations and she can not wear tampons because its so small. My question is at her age what can I expect after the surgery? Can it grow back even at this age? Also she did not have any other adverse reactions to the cream we used on her as a baby. Her breasts are normal size except one seems to be a bit larger then the other. Her doctor says that having one bigger than the other is a common thing. Nothing the cream caused. If anyone has had this surgery at an older age I would appreciate some info on what to expect and how to show her to care for it so it does not happen again.
fire4life from Twentynine Palms, California on December 10, 2011:
I came to this page looking for answers for myself. After reading all of the comments (yes, all of them), I am glad that I did not come here for my baby girl. Especially the pediatrician who's pediatrician forcibly 'fixed' her little girl without discussion. I felt so strongly upon reading that particular comment, that I know that in the same situation, I would not have been able to restrain myself, and I am a very cool customer, not prone to intense empathy, much less genuine outrage.
Many of the other comments saddened me. It seems that there is a lot of bad information out there leading to poor clinical practice, avoidable trauma (both psychological/emotional and physical, whether manual or surgical), and simply inexcusable doctor patient relations. If these pediatricians were communicating effectively, less than half these comments would not be here, because the parents would not have felt the need to resort to the internet for answers to begin with! Part of a doctor's job is to answer the questions that the patient is too overwhelmed or ignorant to ask.
After all, the doc is supposed to be an expert. The patient (or patient's parent(s)) doesn't have years of medical study to inform them. The average American can not be expected to understand much when you start throwing Latin at them... especially right immediately after they realize that you just said their kid's junk is abnormal. That's some scary stuff! Most people I've met don't know much Latin to begin with and get very confused when you start dropping fancy words into the conversation. I imagine that it's a thousand times more difficult to follow under acute stress.
I'm here because I've been battling what I thought was a secondary infection of a sutured wound for the last six months. I thought that, because that's what THREE different doctors told me it was, upon cursory examination. What I believe now, after a quick wikiwalk, is that the inflammation that LOOKED like an infection was actually an adverse reaction to, or rejection of, the dissolving stitches my OB/GYN used before thinking to ask someone known to be hypersensitive to chemicals if they (being I) had ever had them before and could be sure it would be safe or not.
If I'd been given a choice, I'd have chosen not to experiment with my junk. Especially considering I went into it knowing I'd walk out with a tiny invalid to look after. I barely had time or energy to care for myself in those first, most demanding, few weeks. I did not even realize it was a real problem until long after it was supposed to be a fading memory.
My husband has been helping me track the fallout the last couple of months, as I seem to get better one week and worse the next. I finally start to feel almost better and suddenly it's back to dreading toileting so badly that I'm subconsciously allowing myself to dehydrate to avoid having to pee, because urinating on the irritation burns like I'm being branded every time I have to go. Chronic dehydration leads to constipation, hard stools, and anal tears, which makes me even more skittish about using the toilet. Honestly, I've got a nervous disposition, but I manage my anxiety and I've worked through most of my major phobias. I don't need to develop a new phobia now that my functioning level of paranoia is almost indiscernible from 'normal' people.
Tonight... well, I guess last night, now. Last night I felt a weird tension, a pulling sensation, that wasn't there before. I had my husband check my injury and he said it's very strange, but that it was both better and worse. The worst of the swollen bits was much improved, but it had somehow fused to one of the smaller sores on the opposite side.
Most of the original tears were really no more than minor abrasions of the vulval vestibule, with the worst tear separating the posterior edge of one of my minor labia from the perineal area. Which, oddly, was the part that caused the least trouble while healing, though it will never be like it was before (which would be a lot to expect after having a baby, at any rate!). I believe that at this stage, my labia are just doing the best they can given the circumstances.
I am breastfeeding a greedy little glutton, who (even at six months!) thinks she's starving to death if she isn't eating every two to four hours AT NIGHT, every twenty to thirty minutes for at least two hours twice a day, and no more than ninety minutes to two hours the rest of the day. I attribute the constant feeding to being very small chested, and I really don't mind. I've been an insomniac most of my life and have struggled with it on and off over the last year. She sleeps, someone has to. (Thank goodness she's taken after her daddy! They'll sleep most of the night and half the day if you let them stay in bed! She fights sleep when she aught to nap if there's anything even remotely interesting going on though, so I guess she got something from me in that regard, too.)
I think the idea that babies should sleep through the night without care is ridiculous, though. Just because she sleeps through, doesn't mean I get to. She needs two to four diaper changes most nights, very occasionally she stays dry all night, but I always check at her regular times. Like I said, I don't mind the midnight snacking, but it's easy to handle since we co-sleep and I still have to get up to wash my hands after diapering, which requires significantly more effort than breastfeeding. I could see it being a pain for formula babies, so maybe that's where the impression comes from? I didn't sign up to take shortcuts, so I don't resent losing precious sleep. I just value what sleep I do get that much more.
Besides... what could be sweeter or more indulgent than getting to curl up for a nap with the cutest cuddlebutt ever born on a slow afternoon? (Of course, we all think ours is the best, but mine really is ;) ) Speaking of which: in the time it took to read all of these comments and ramble on, I've had to stop three times to do rounds of feeding and diapering, the last two only an hour apart. It is now morning, so I'm going to try to sleep. Days like this make me really glad that we planned for an extended maternity leave. No work for the weary! I get to be a zombie all day and hubs will change a couple of diapers!
sissy on September 17, 2011:
my daughter is 20 months old and has surgery in 6 days she has been on the cream for 6 months with no luck. she is so closed that they couldn't even get a cather in her for test on her bladder for her other med problems. she was born with congenital scoliosis and spina bifida her scoliosis curves to the left and can affect all of her major organs the doctor said her curve is already at 40 degrees lying down so we don't know how bad it will be when she has a xray standing up in nov. please pray for her.
soflagal on September 07, 2011:
I am so thankful for this article and the informative comments. My daughter is 7 years old and was diagnosed as an infant (actually, her twin has no problems with this.) We were initially given the Premarin which did nothing but irritate her, and which made me very uncomfortable to use due to the hormones. We have had no problems with uti or urination at all but she just started telling me she is dribbling after she urinates. I think I will try the flax first and if that doesn't help I will schedule a ped urology visit.
I would appreciate hearing from anyone whose child had the surgery and what the recovery was like. (She is in first grade and I want to be sure she has enough recovery time at home before heading back to school, so might possibly schedule a procedure before Thanksgiving.)
kristin on August 25, 2011:
my daughter is now 19 months old. we found out about her adhesions at her 6 month well checkup. the doctor notices them and put her on premarin cream and it didn't work at all. we took her to have the surgery done and they also did a cystoscopy(she was only having 1-2 diapers a day at 8 months old) and 2 months after it was lasered open, it came back and now we are waiting for her to hit puberty. she was on an oral medication from month 8 to 13 months. after she came off of it, she was having febrile seizures occasionally and fevers once a week. it has all stopped now, thank God! but we are still fighting with the adhesions. it hurts every time we wipe her and she doesn't want to potty train anymore (we started practicing potty time at 14 months).
Louise on May 10, 2011:
Hi, Just to let you know that my 4 year old daughter just had surdery last month on her 'bits' as she calls them. So far, best thing we could have done. She had quite bad adhesions, and so far the surgery seem to have done the trick. It was relatively simple - the operation and didn't upset her that much... just a few painful wees in the bath afterwards. I am happy to chat about my experiences if anyone wants to.
Shirley on April 01, 2011:
I've just found I had it and I'm 17 and I've become so upset about it. I don't feel like it's normal at all. I apparently had it at six weeks old and that all they did was 'apply estrogen cream' but It has sort of depressed me a little. I'm extremely upset.
magmouse1 on March 25, 2011:
Thank you for all the information and reading from a Dr. is a blessing. My daughter is 10 and has had this since birth. As a toddler we tried the Premerin, as a mom my gut told me don't do it so I stopped after 2 weeks and decided to just let it be. For a couple of years it seemed to cause no problems at all. At the age of 7 the UTI infections began, urination combined with different antibiotics causes diarreha and a constant reminder to my daughter that "something" is wrong with her vagina. I worry about her sexual intimacy later in life and worse that she asked me the other day if she would ever get to be a mommy. Last week the urologist(not pediatric)referred us to a GYNO for the surgical procedure. I'm so frightened of scarring her for life and don't know what to do. Seems by reading here that even surgery does not work. My insticts as a mother say no don't do it. One of my concerns though is that she will start her period and this will not be resolved. We live in California. What do I do?
Viola on March 17, 2011:
My daughter is almost 8 and this is her second time with adhesions. The first time, ( approx 6 yrs. old) the MD ordered Premarin cream which made her begin to devolop dark pubic hairs and breasts which now she has to wear a bra daily in the second grade. She is complaining of urinary retention and etc, urinalysis show no bacteria but yet as she urinates she cries that it is so weird feeling. The doctors seem uncaring about this but it isn't his kid sitting there crying on the toilet. This site has been so helpful and made me realize that my daughter is not the only one out there experiencing this. We go back to the MD tomorrow for the second time this week, the other day he only ordered baking soda baths and hydocortisone cream to the labia, its ridicoulus. Thank you everyone for sharing your stories.
MotherOfPearl on March 03, 2011:
They say, don't freak out. How can I not freak out when I see words like UTI and infections!!? I'm so sad right now.
MotherOfPearl on March 03, 2011:
Pardon me... MotherOfPearl and AmazingAmazon are the same person.
AmazingAmazon on March 03, 2011:
Also, I'd like to mention that her case is mild. The doctor didn't seem too worried and asked me to keep an eye.
MotherOfPearl on March 03, 2011:
As my eight-month old sleeps, I read your comments and wonder what to make of all the different points of view, Ladies. I'm confused as to what the common voice is here. Here's my own small list of specific questions. Please, someone reply...
1- While bathing my baby, I wash her with baby wash rather nicely in the name of good hygiene. Now, when I read labial adhesion could be a result of soap irritation, I blame myself for bringing this upon my innocent child. Am I right in thinking this way. Also, I don't change her diaper during the night. Should babies be changed more frequently?
2- Her doctor has prescribed A&D ointment. Is that okay to use, or does it have side-effects, too?
3- A&D ointment vs leave it alone? What's better?
4- Do I need to completely dry the specific area before applying cream/flaxseed oil?
5- Is olive oil a good idea?
6- How do I prevent rash in that specific area? I use cornstarch with every diaper change, but I don't go there?
7- Does this condition hurt, irritate or make babies uncomfortable?
Brooke on February 22, 2011:
Hi I just found out my daugherty has this but hers is a little diffrenet she has a problem that she got from me we are both very extra sensitive down there and get infections very easily whice irritate that area which makes it worse and close more so she has to be very clean at all times she is not allowed to take a bath only showers she has to wipe with baby wipes not tolit paper and has to spray water down there after waking up and playing outside anytime she swets and anything she sits on needs to be cleaned so we can do what we can to keep her clean so it doesn't close anymore she will live with the sensitivity for ever but will more than likley grow out of the labial adhesions so make sure if your child has this that you keep them clean becAuse it could make it worse.
Lisa on February 21, 2011:
Thank you so much for the information!! We just found out that my 2 yr old daughter has this. She also has been getting UTI's so this might be the cause. The picture was also very helpful.
Still Worried on February 09, 2011:
My daughter who is almost 2 now has been battling these adhesions since she was just over 10 weeks old. At first it was not much of a concern, our pediatrician mentioned the adhesions but did not think there was any need for concern. About 6 months ago, FINALLY most of her 'adhesions' had cleared up at least enough to reveal yet another concern. That she is absent a vaginal opening. We were then sent into a whirlwind of questions that no mother want's to consider and sent off to a Pediatric Gynocologist at Children's Hospital. He examined my daughter with the utmost respect and believes that the absence of an opening is due to a very thick adhesion that is covering the opening, however there are other things it could be and we simply won't know until puberty. Once she hits puberty the natural hormones of a girls body will cause the adhesion to dissolve and hopefully it will reveal all the normal parts and functioning of a normal female. I am not posting this to scare anyone, but it is important to keep up with the adhesions so you can know your daughters anatomy and advocate for her at her appointments. We are back to the doctor tomorrow because her adhesions have worsened and she is pretty much zipped up all the way to her urethra and I am concerned she will get a UTI (which my first daughter got often as a baby and it is horrible). If you don't keep an eye on these adhesions and use the vaseline (in our experience) they will continue to get worse. I have to use vaseline after every diaper change, change her diapers often, as well as put her in a tub of warm water daily for at least 20 minutes to help keep the natural healing bacteria of her body at bay and not trying to heal her together in her neither regions. We are still worried about the other diseases as they can be very difficult for girls as they get older but we must just wait and see.
Nervous Mom on February 01, 2011:
About two months ago, my one year daughter was diagnosed with a labial adhesion. She was prescribed the Premarin and despite my apprehension, we used it for three weeks and her issue cleared up fairly quickly. I was uncomfortable with giving my one year old hormones, but I trusted her pediatrician. Now, two months after the initial diagnosis, it has come back, though I think we caught it before it got too bad. What concerns me most, besides using estrogen to clear up this problem, is that from all that I've surmised from others on the internet, it seems that this issue will repeatedly come back. My daughter's doctor made it sound as though it was just a matter of changing her diapers frequently. I do change her frequently but we've still go the problem. I now wonder if it has anything to do with the fact that she is in cloth diapers. On top of that, the nurse I spoke with last suggested using petroleum jelly at each diaper change. And maybe I'm being a bit too squeamish, but I just feel really uncomfortable with having to get into my daughter's "business" at every diaper change. It seems too much and she's starting now to get to the age wherein she's resisting more. She has had no UTI as of yet and seemed to be in no discomfort when the adhesion was at it's worst. I'd really like to just let it be and see what happens from there but I guess I'm feeling pressure from the pediatrician. I don't want to end up with my daughter in worser condition but I also don't want to somehow scar her both literally and figuratively at every diaper change. I appreciate Dr. Michelle's words above but don't feel as though our pediatrician will have the same sensitivity. Maybe I'm over analyzing things. We see the pediatrician again in another two weeks and I think I'll just be honest with my apprehensions and just stick to the Premarin for once a day for now. In the meanwhile, if anyone has any more natural remedy (i.e. diet or something), I would really appreciate it. Thanks.
Janette s on January 30, 2011:
I discovered my daughter had this problem 4 yrs ago, she is now 6.We went with the cream and it did work but it closed back up again not long after.We were advised by a gynaecologist not to continue with the cream.Now at 6 yrs old she has developed a constant discharge of which we are awaiting pathology reports.Now we are reconsidering our options.She is wearing a mini pad to school that frequently needs changing by me.This imformation on the net is very useful, but we are still undecided of what course of action to take.Any advice would be helpful.She is my fifth child and I thought I had seen it all at nearly 50 yrs old, obviously not as this has shocked and bewildered me.PS a photo 4 yrs ago would have been helpful
Katie on January 18, 2011:
When I was little I had fused labia, at least I know that's what its called now. I was very young but I remember going to the doctor and they would rip the opening back open. Id have to ask my mom but back then (I'm the 80's) they didn't offer up cream.
My whole life I have had a separate little hole, it's like a thin piece of skin creating an alternate entry into my vaginal area. I've had tampon strings get wrapped around it. Sex and other activities can hurt if it goes in there.
Just today I had this corrected. Once the pain and swelling go down I'm hoping it gets better.
lisa on December 15, 2010:
Today i changed my grandaughters nappy and found she has this condition,I am glad i googled this,as we were sure she used to have an opening,(we thought we going crazy)now reading articles i know shes going to be ok thanks a not so worried granny
cynthia on December 08, 2010:
MY DAUGHTER HAS HAD THIS PROBLEM FOR YEARS. IT STARTED WHEN SHE WAS 8MONTHS AND NOE SHE'S 4 YEARS OLD THEY GAVE ME A CREAM AND IT WORKED IT OPENED AND THEN CLOSE SO NOW SHE'S GOING TO THE DOCTOR AND THEY SAID SHE WILL HAVE TO SEE A SPECALIST.
THIS HAPPENED TO MY FIRST DAUGHTER AND IT ALL WORK OUT FINE BUT WITH MY YOUNG ONE IT'S A BIT MORE HARDER. I JUST HOPE IT ALL WORKS OUT WITHOUT SURGERY
Angry Pediatrician on November 15, 2010:
So my daughter's one year well child was today, and she was found to have labial adhesion, and then forcefully opened manually by her pediatrician with NO WARNING. He said that it was good we found it now so we didn't have to mess with creams and such later. Are you kidding me?? She has been crying with every diaper change and every time she urinates. I have never been so angry. And get this.... I'm actually a pediatrician too. I take my kids in for their shots and for another set of eyes to make sure they are fine. Never again.