What are labia?
Labia is the medical term for lips and can be used to refer to the lips of female genitalia. The labia cover and protect the urethral opening (the urethra is the passageway to the bladder) and the vagina. There are two outer lips, the labia majora, and two inner lips, the labia minora.
The labia majora are usually covered with sparse pubic hair and are considered a skin structure. The labia minora are an interface structure with an outer hair-free skin surface and an inner mucosal surface. The labia minora look like flaps or wings, and they can be a few millimetres to several centimetres in length.
What is labial adhesion?
Labial adhesion means that the labia minora are stuck together or fused. Adhesion rarely results in complete labial fusion; more often it is partial. The adhesion may also be called bridging, as the right and left side of the vulva are joined together. Labial adhesion may also refer to fusion of labium minor with labium major.
What causes labial adhesion?
Secondary labial adhesion may be due to oestrogen deficiency, particularly in non-sexually active women after the menopause. It may also be caused by scarring or fibrous tissue that forms after severe inflammatory skin disease, surgery or trauma. The most common causes of labial adhesion in adult women are listed below.
- Oestrogen deficiency associated with atrophic vaginitis
- Vulval lichen sclerosus
- Erosive lichen planus
- Mucous membrane pemphigoid
- Behçet syndrome
- Stevens-Johnson syndrome / toxic epidermal necrolysis
- Vulval cancer
- Complications of childbirth
- Female circumcision operation (which is illegal in many countries)
- Complications from vulvectomy
What are the clinical features of labial adhesion?
Labial adhesion joining the left and right labia minora results in a narrowed vaginal opening (the vaginal introitus).
The vaginal introitus is normally several centimetres in length and in adults can easily stretch to accommodate a penis during sexual intercourse, and at the end of pregnancy, a baby's head. When the labia are fused together, the opening is smaller and the skin can't stretch. The introitus can be as small as a pinhead when labial adhesions are severe. Symptoms may be absent or the adhesion may lead to:
- Dribbling urine on standing up after passing urine
- Painful sex (dyspareunia)
- Itch and soreness.
Adhesion between a labium minor and corresponding labium major results in resorption, shrinking or disappearance of the labium minor.
Characteristics of labial adhesion
- The genitalia has a flat appearance.
- The labia minora are small or absent.
- Fusion may affect anterior vulva or posterior vulva or both.
- Anterior fusion is often associated with disappearance or fusion of clitoral hood (the skin covering the clitoris).
- Posterior vulval fusion may be due to scarring of the perineum (the tissue between the vagina and anus).
- The affected tissue does not stretch properly (loss of elasticity).
Other features depend on the condition causing labial adhesions and may include:
- Colour changes (white from scarring, red from inflammation, or brown from previous inflammation)
- Blisters, erosions and ulcers
- Patches or lumps.
The internal tissues of the vagina may be quite normal but inflammation and scarring may affect the vaginal lining as well as the external genitalia in some inflammatory skin disorders, particularly erosive lichen planus and mucous membrane pemphigoid. The vagina may also be scarred following surgery or trauma.
What are the complications of labial adhesion?
Partial labial adhesion may be unobserved but often, symptoms and complications arise. These include:
- Tissue splitting with painful fissures at the top and/or bottom of the vaginal opening (see fissuring of posterior fourchette)
- Difficulty or inability in inserting a tampon during menstruation
- Inability to have normal sexual intercourse (apareunia)
- Difficulty in wiping dry after passing urine
- Dribbling of urine that has formed a puddle behind the fused tissue.
Complete labial fusion means that urine and vaginal fluids including menstrual blood build up behind the fused labia; this is an emergency and urgent medical assistance should be sought.
What treatment is available for labial adhesions?
Treatment depends on the cause of the fusion. It does not always require specific treatment.
- Intravaginal oestrogen cream, most often prescribed after menopause
- Manual division by gently stretching the two sides until they separate
- Topical corticosteroids to control inflammation
- Regularly stretching the opening using fingers, vaginal dilators or regular sexual intercourse
- Surgery to remove scar tissue (Fenton procedure)
- Surgery to bring out uninvolved vaginal tissue to the skin surface (perineoplasty)