Multi-disciplinary intervention for labial fusion in a case of vulval lichen planus.

Vulvo-vaginal lichen planus is a very distressing and rare forms of non-venereal genital dermatoses. Erosive variants of Lichen planus often have a protracted course and has a higher risk of malignant transformation. This case was a 53-year- old woman, previously diagnosed with lichen planus on conservative treatment, who now presented with symptomatic labial adhesions and urinary complaints like urgency, frequency and poor urine stream. Clinical examination revealed normally developed labia majora, partially but extensively fused labia minora including the clitoral hood. Urethral opening was not visualised, while a small vaginal orifice was seen with no ulcerations. A multi-disciplinary team consisting of urologist and plastic and cosmetic surgeon dissected out the labial adhesions with the electrocautery and reconstructed the vaginal and urethral openings. Cystoscopy followed by urethral dilatation was done for urethral narrowing. Postoperatively, on following up the patient the adhesions were completely separated, and the area healed well. No recurrences were noted. Though aggressive management with topical steroids and other measures often improves symptoms on short term basis, few patients may require long term management by multi-disciplinary team to optimize the outcomes.

Labial fusion: A rare cause of obstructive lower urinary tract symptoms in old age females

Lower urinary tract symptoms in females can be due to various factors. Most of the time it is due to simple urinary tract infection and lower urinary tract pathology such as urethral stricture, meatal stenosis, bladder stones, underactive detrusor, and primary bladder neck obstruction. Commonly found neurologic causes among females are detrusor–external sphincter dyssynergia, associated with various brain and spine diseases and diabetic neuropathy. Labial fusion is a rare cause of female voiding difficulty. We herein present two elderly postmenopausal diabetic female patients who had nearly total urethral occlusion due to labial fusion. After thorough history taking and local genitourinary examination, the patients were operated. Treatment included surgical correction followed by the local application of 1% estrogen ointment. Both patients were symptom-free after the procedure. Thus, with a correct diagnosis followed by simple operative procedure, we can treat such patients successfully.

Severe labial adhesion causing lower genital tract obstruction and bilateral pyosalpinx in an adolescent girl / 대한산부인과학회지

Labial adhesions are extremely rare in adolescent and adult populations, because the etiology of this entity commonly relates to chronic vulvar inflammation or irritation, and is basically associated with low estrogen status. Although a few cases reported urinary retention resulting from severe labial adhesions, there is no report of labial adhesion that precipitates upper genital tract infection in prepubertal and postpubertal females. We present a rare case of severe labial adhesion and consequential lower genital tract obstruction that allegedly causing bilateral pyosalpinx in a 14-year-old adolescent girl who decisively denied sexual experience. The patient was successfully treated with surgical lysis of adhesion and administration of antibiotics.

Labial Adhesions in Children: Report of Two Cases

Labial adhesion in prepubertal girls is a common gynecologic problems. The labia minora are fused by thin transparent or thick fibrous membrane in the midline from the clitoris to posterior fourchet. The prevalence of labial adhesion may be even greater because many children with labial fusions are asymptomatic and these cases remain unreported. They are often unrecognized by physician and parents because most of symptomatic children complained urinary symptoms. The authors experienced 2 cases of labial adhesion in girls; one asymptomatic partial fusion and the other symptomatic complete fusion. These lesions were treated successfully by mechanical separation of labial adhesion and petroleum ointment (Vaseline) application without recurrence in follow-ups.

A Case of Labial Adhesion

Labial adhesions are postnatal fusion of the labia minora in the midline of varying degrees. They are postulated to be the result of low estrogen levels in the prepubertal child and possibly of a chronic inflammatory process. Topical treatment with conjugated estrogens has been the mainstay of therapy. We experienced one case of labial adhesion in an infant who was treated with estrogen cream for three weeks without any complication. Here we present this case with a brief review of the literature.

Labial Adhesions in Children / 대한비뇨기과학회지

Labial adhesions are rather uncommon genitourinary disease in children which result from local inflammatory process. Three children with labial adhesions were managed with 0.625mg% estrogen ointment successfully without any significant side effects except mild pigmentation. Another 1 child with mild adhesion of the posterior fourchette only is under observation now. Local estrogen ointment application is simple, safe and successful mode of treatment in children with labial adhesions.