Introduction

Labial fusion, also known as labial adhesion or agglutination, involves the adherence of the labia minora across the midline, forming a thin membrane that may obscure the vaginal introitus. Usually, a small anterior gap persists, permitting urinary and menstrual flow. (1,2)

This condition is commonly seen in pre-pubertal females due to low estrogen levels and often resolves spontaneously after puberty. It is also frequently observed in postmenopausal women for the same reason.(3,4)

Adult cases are rare, especially in women of repro-ductive age.(6) Etiological factors include low estr-ogen levels, recurrent vulvovaginitis, poor hygiene, chronic irritation, lichen sclerosus, or trauma.(10)

While often asymptomatic, symptomatic cases present with urinary complaints, recurrent vulvovaginal infections, or menstrual obstruction. Severe fusion may mimic obstructive anomalies such as a microperforate hymen or a transverse vaginal septum, making careful clinical examination essential.(8)

Management depends on severity and age. In children, topical estrogen or corticosteroid creams are highly effective, while adults and adolescents with dense or symptomatic adhesions generally require surgical adhesiolysis. Recurrence rates of 11-14% highlight the need for preventive measures such as local hygiene and emollient use.(9)

Case Report

An 18-year-old unmarried girl presented to Gynaecology OPD at Rajindra Hospital, Patiala in October 2023 with history of three months of pelvic pain during menstruation, urinary hesitancy, and incomplete bladder emptying. She also reported intermittent vulval itching for last four years. She had noticed labial fusion about a year ago but became symptomatic in last 3 months.

There was no history of trauma, sexual activity, or use of local/herbal/hormonal or steroidal medications. Menarche occurred at 14 years with regular and painless cycles. Family and medical history were unremarkable. Accompanied by her mother, the patient was examined and was found to be moderately built with normal secondary sexual characteristics appropriate for her age.

Figure 2: Intra-operative view after spontaneous adhesiolysis, revealing urethral meatus, labia minora, and vaginal introitus with restored anatomy.

Postoperatively, the local dressing was done daily with a lubricated gauze of soframycin which was placed between the labia, and an indwelling foley’s catheter was retained for five days. She received oral antibiotics and analgesics and was discharged satisfactorily on day seven.

At one-month follow-up, she reported normal menstruation and no urinary complaints. At three months, genitalia appeared normal with well-separated labia and no recurrence.

Discussion

The exact cause of labial fusion remains unknown. However, labial adhesions are believed to arise during the re-epithelialization of labial skin that has been microtraumatized, often in the setting of low estrogen levels, vulvovaginitis, or inadequate local hygiene. In prepubertal girls, contributing factors may include hypoestrogenism, genital trauma, or a history of sexual abuse.(8,9)

The diagnosis is usually clinical and established by careful inspection of the external genitalia. In adolescents and young women, it is crucial to differentiate labial adhesion from other obstructive anomalies such as microperforate hymen, as misdiagnosis may delay appropriate management. Hence, meticulous local examination must not be omitted in the evaluation of patients presenting with menstrual or urinary complaints.

The follow-up period was relatively short, preventing assessment of long-term recurrence or complications. Hormonal evaluation and histopathological assessment were not performed, which could have provided additional insights into etiology. Finally, conservative therapy with topical estrogen or corticosteroids was not attempted prior to surgery, and thus, the efficacy of non-surgical approaches in this patient could not be evaluated.

CONFLICTS OF INTEREST

The authors declare that they have no conflict of interest.

SOURCE OF FUNDING

The Authors received no financial support for the research, authorship, or publication of this article.

References