I just had contact this past weekend with a mom whose 9 month old also has
the labial adhesions.  May I share the info with you that I shared with her?
First, it is NOT caused by breastfeeding/hormones!

By far the most common form of vaginal obstruction in little girls is fusion
of the labia minora as a result of labial adhesions. These are typically
diagnosed in girls from 6 months to 6 years of age. Diaper rash, infections,
irritants, or mechanical trauma commonly cause chronic inflammation of the
labia. Occasionally the inflammation is the result of chronic sexual abuse.
Whatever the cause, as the labia try to heal, fibrous tissue adheres the
labia to each other. Some girls are prone to forming adhesions no matter how
careful the parents are. The adhesions result in a smooth membrane over the
vulvar opening with a thin, pale line at the center. This surface membrane
usually starts forming at the rear of the opening, and 'zippers' closed
toward the front. Usually, a sufficient opening at the front remains to
permit urine and vaginal secretions to exit.

The adhesions will often resolve spontaneously when girls are out of diapers
or pull-ups both day and night. When labial adhesions persist, the estrogen
surge at puberty will correct the problem. If there are no complications,
such as infections or obstruction, the adhesions do not need to be treated.
If treatment is needed or preferred, the natural process can be accelerated
with the application of topical estrogen. A hormone cream, such as Premarin,
should be applied twice daily for two weeks, and then nightly for an
additional week, if necessary.

"Labial adhesions -  this condition occurs because the sides of the vaginal
opening are so close to each other that they begin growing together. This
does not cause baby any discomfort or harm. Oftentimes these adhesions open
by themselves. But if the adhesions are becoming thicker or obstructing the
whole orifice ***enough to block the flow of urine,*** your doctor may
gently open the adhesion. If they continually grow back, the doctor may
prescribe an estrogen cream to be applied around the edges to prevent
further adhesion. Around two years of age, as your daughter begins producing
her own estrogen in this tissue, the labial adhesions will subside.


Majority of cases will resolve without any therapy within 18 months.
Therefore, reassurance is all that is necessary in most cases. If you
manually break the adhesions, they will reform unless you put petroleum
jelly on the edges.


Once the labia separate, apply antibiotic ointment for several more weeks to
allow complete healing.

Adverse systemic effects from estrogen application are rare and reversible
once treatment is stopped.

HOW DO LABIAL ADHESIONS DEVELOP?
Irritation that may be minor enough to go unnoticed generally precedes the
development of labial adhesions. As the irritation heals, new cells on the
edges of both labia minora stick to each other as if they were part of the
same structure. In a short time, the two labia are fused into a single
membrane. The cause is unknown.

Once labial adhesions develop, urine buildup behind the membrane may lead to
further irritation, creating a kind of vicious cycle in which inflammation
never subsides completely and the labia remain fused.

WHEN SHOULD I SUSPECT THAT MY DAUGHTER HAS LABIAL ADHESIONS?
A quick visual inspection of the vulva during a diaper change should alert
you to the presence of labial adhesions. Pediatricians generally perform
such examinations during routine checkups as well.

Most of the time, adhesions themselves produce no symptoms. In some cases,
there may be discomfort and difficulty urinating. If the adhesions are
causing soreness, the child may rub the vulva excessively.

HOW ARE LABIAL ADHESIONS TREATED?
No treatment is necessary unless the adhesions are associated with repeated
urinary tract infections and pain on urination.

If the adhesions require treatment, the pediatrician will prescribe an
estrogen cream to be applied to the labia. This treatment, which usually
continues for about a month, resolves almost all adhesions, although
continued application of petroleum jelly may be necessary to keep the labia
from fusing again. It is not advisable to separate the labia forcefully or
with surgery, since the trauma of these procedures often leads to further
irritation and repeated formation of adhesions.



Ann Marie

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