In labial synechiae, the labia minora adhere to each other and can provide a breeding ground for bacteria as they progress, favoring urinary tract infections and even hydonephrosis. The most common cause of the phenomenon is trauma to the epithelial layer. Treatment is by daily application of an ointment with active ingredient estrogen.
What is labial synechiae?
Labia minora is the name given to the labia minora. A synechia is also known to medicine as adhesion. When the labia minora adhere to each other, either completely or proportionally, the condition is known as labial synechiae. The prevalence of the disease is given as two to five percent. It mainly affects girls between the third month and the fourth year of life. Labial synechiae reaches its peak between the 13th and 23rd month of life. In individual cases, labial synechiae can also exist immediately after birth. However, in labia minora synechiae there are no direct adhesions. This relationship distinguishes labial synechiae from any malformations due to a genetic cause, external influencing factors during pregnancy, and disturbances in embryonic development.
Causes
Labial synechiae can have several causes. For example, trauma leads to abrasion of the superficial epithelial layer. In this way, scarring may occur, resulting in adhesion of the two labia. Types of trauma in this context include inflammations such as vulvitis or vulvovaginitis. The cause of such inflammations can be a lack of hygiene. Seborrhea or atopic dermatitis can also cause inflammatory reactions. The same applies to pinworms, laceration of the labia minora or spagath. In addition, sexual abuse and masturbation are possible causes of trauma. In individual cases, estrogen deficiency is the primary cause of labial synechiae. In such a deficiency, the strength of the epithelial cells may be reduced. Trauma to the labia is thus at least favored.
Symptoms, complaints, and signs
Labial synechiae manifests clinically in a variety of symptoms. Most symptomatic is abnormal micturition. In addition to an aberrant urine stream during the actual act of micturition, severe postmicturition dribbling may occur. In some cases, obstruction has also been observed, which may be associated with bladder dilation or hydronephrosis. About one third of all patients frequently suffer from urinary tract infections due to the adhesion of the labia minora. Bacteria collect in the adhesion area of the labia minora and migrate into the urinary tract, where they cause the inflammation. About 20 to 40 percent of female patients are affected by this symptom. Alternatively, the manifestation may correspond to asymptomatic bacteriuria. In this case, bacteria accumulate but are excreted with micturition and do not cause urinary tract infections or other sequelae. Since vulvitis is considered a possible cause of labial synechiae, such inflammation may complete the clinical picture in individual cases.
Diagnosis and course of the disease
The diagnosis of labial synechiae is made on the basis of the clinical picture. Because most girls with adhesions of the labia minora remain relatively asymptomatic, the physician often detects the synechiae as an incidental finding during a routine examination. Urogenital findings include a flat vulva and adherent labia from the midline to above the clitoris. The labial membrane shows through thinly over the introitus and hymen. The prognosis for affected patients is favorable. The symptoms mentioned above, such as the deviated urine stream, post urination dribbling, bacteriuria and urinary tract infections, usually occur late in the course. Thus, after early detection and subsequent treatment, most patients remain completely asymptomatic. Further workup is usually not indicated for adhesions of the labia minora.
Complications
Infections of the urinary tract usually occur because of labial synechiae. These infections can be very unpleasant, including pain during urination. Not infrequently, patients are ashamed of this complaint and suffer from burning pain.Due to the permanent pain, depression or other psychological upsets and complaints may also occur. Furthermore, the patient’s sexual intercourse is also significantly restricted due to the labial synechiae, so that it can lead to tensions in a relationship. The quality of life of the affected person is significantly limited and reduced by this disease. In most cases, the treatment of this disease is carried out with the help of medications, creams and ointments. The treatment usually leads to success and there are no particular complications or other complaints. As a rule, the course of the disease is positive. Only in rare and severe cases do patients require surgical intervention. The patient’s life expectancy is not reduced or limited. Further complications also do not occur.
When should you see a doctor?
Women who have problems urinating should talk to their gynecologist. Medical advice is also needed if urinary tract infections occur repeatedly or other unusual symptoms are noticed in the genital area. Complaints that persist for a long time or recur after a symptom-free period indicate a serious condition such as labial synechiae, and must therefore be investigated. Burning pain during urination as well as problems during sexual intercourse are an indication that the disease has already progressed. To avoid risking further complications, affected women should talk to their gynecologist immediately. Parents who notice signs of labial synechiae in their child should not hesitate to visit the doctor. Inflammations in the intimate area as well as hormonal complaints are possible triggers of the adhesion of the labia. Worm infestation and eczema in the vaginal area are also possible causes that need to be clarified. If the symptoms occur in connection with the above-mentioned diseases, it is best to consult a specialist directly. In addition to the gynecologist, an internist or a dermatologist can be consulted.
Treatment and therapy
Labial synechiae is never solved manually. The risk for traumatic injury to the epithelial layers is high if the adhesion is loosened manually. Scarring often remains, and recurrent adhesion may be favored. Neither is manual solution indicated for surgical separation of the labia. Treatment is conservative and limited to therapy with conjugated cream of the active ingredient estrogen in asymtomatic cases. Premarin is used particularly frequently. The patient or the patient’s parents are instructed to apply smaller amounts of the cream to the site of adhesion each day. Depending on the severity of the adhesion, twice-daily application of the cream may also be necessary. Usually, this treatment resolves the synechiae of the labia minora within one month at the latest. The cream treatment has a success rate of about 90 percent. If a urinary tract infection is already present, the patient is also prescribed antibiotics to combat the bacterial colonization. The same applies if vulvitis is present. Surgery is indicated only in the case of obstruction with hydronephrosis. The procedure removes the obstruction and ideally resolves the hydronephrosis at the same time.
Outlook and prognosis
The prognosis for labial synechiae is usually very favorable. Life expectancy is not limited by the disease and there are no late sequelae. Especially in affected girls under the age of six, there is often rapid healing without further complications. In many cases, the adhesion of the labia dissolves by itself within a few weeks or months. In some patients, it is completely asymptomatic during this time. Labial synechiae does not always require actual medical treatment. Treatment usually leads to quick success. Therapy with estrogen-containing creams brings about a rapid improvement in symptoms. Within a few weeks, labial synechiae dissolve completely. Especially if the therapy is discontinued prematurely, the labia may become stuck together again. Repeating the treatment usually leads to complete healing. However, if the condition is not treated for a longer period of time despite severe symptoms, complications may occur.This rarely necessitates surgical treatment, which is usually performed on an outpatient basis. In this case, the prognosis is generally very good. However, scarring of the affected tissue may occur, which usually heals within a few months.
Prevention
Prophylactic treatment steps are available to prevent labial synechiae. This prophylaxis is used primarily to prevent recurrence after adhesion of the labia minora and its resolution. The most common prophylaxis is the application of Vasiline once a day in the area of the previous adhesion. If there has never been a history of adhesion, any prophylactic measures are usually not necessary.
Follow-up
The patient usually has few, if any, special options for follow-up care when a labial synechiae is present. First and foremost, the disease should be diagnosed and treated quickly to prevent further complications and discomfort. As a rule, the disease cannot be cured on its own, so treatment by a doctor is always necessary. In most cases, the disease is treated by applying a cream. Here, the affected persons should pay attention to a correct application and also to a correct dosage of these medicines. In many cases, the parents of children must also monitor the correct application so that the symptoms are alleviated correctly and, above all, permanently. Since labial synechiae is accompanied in many cases by a strong feeling of shame and also by reduced self-confidence, loving and intensive discussions with the child are very helpful and important. Contact with other affected persons can also be useful, as this leads to an exchange of information. These can then make the patient’s everyday life easier. As a rule, labial synechiae does not reduce the patient’s life expectancy.
What you can do yourself
As a rule, no special self-help options are possible or necessary for labial synechiae. In this case, the treatment of the disease is carried out with the help of creams and ointments, and surgical interventions are not necessary. The cream should be applied no more than twice a day so as not to irritate the skin. Since labial synechiae can also lead to urinary tract infection, the patient should consult her gynecologist or a urologist to avoid further discomfort. Treatment of these infections is usually carried out with the help of antibiotics. At the same time, the affected person should avoid alcohol and possibly treat possible interactions with other medications. In order not to delay the treatment of labial synechiae, the affected person should also refrain from sexual activity during it. In the case of psychological complaints, depression or inferiority complexes, discussions with close friends or with the partner are suitable. Above all, the reduced self-esteem can very often be increased by this. Possibly, the exchange of information with other affected persons can also contribute to a positive course of the disease. However, psychological treatment is necessary if the labial synechiae occurred as a result of sexual abuse.
