Fusion of labia minora is a common condition in small girls, just as preputial adhesions can be seen in boys. These conditions are secondary to low levels of estrogens and androgens in this age.

Labial adhesions usually proceed from the back sometimes leaving only a small orifice for urine outflow  just under clitoris. This can lead to vaginal reflux and persistent vulvitis, sometimes urinary track infections.

In other cases the urine that gathered in the vagina evacuates for a couple of minutes mimicking urinary incontinence. In this cases separating the labia gives the patient instant improvement in quality of life.

Small adhesions partially covering vaginal orifice are asymptomatic and will spontaneously resolve with time.

Treatment

In short fusion or when parents do not accept surgical management I suggest estrogen cream – Ovestin – for 2 weeks. It should be applied locally twice a day and the labia should be gently pulled apart with mothers thumbs. This is really effective, but surgical treatment is even more.

The area is covered with local anesthetic – lignocaine – and then separated with dissector, which is not a sharp edged tool at all. It takes 15 seconds and parents are present. Small girls, which are usually less frightened, sometimes do not react at all. Separated labia heal for a few days and are prone to recurrent adhesion in these days. Proper parental care is a key to success here.