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A labial adhesion is defined as a thin avascular clear plane, a raphe, between the labia minora. These adhesions which can be caused by minor trauma or infection in the absence of estrogen can cause varying degrees of obstruction.
The prevalence is between 0.6% and 5% of females and occurs between 3 months and 3 years of age with a peak between 13 and 23 months. At least 50% are asymptomatic and found incidentally. Patient may also have a UTI (20%), postvoid dripping (13%), urinary frequency (7%), or vaginitis (9%). First-line treatment: estradiol cream 0.01% 1-2x/day for 2-6 weeks. Gentle traction during application of the cream increases the success of separation. The success rate is between 50% and 89%. Apply an emollient to reduce recurrence rate. If there are severe symptoms or medical therapy fails, surgical separation is recommended.
References
Loveless M, Myint O. Vulvovaginitis- presentation of more common problems in pediatric and adolescent gynecology. Best Pract Res Clin Obstet Gynaecol. 2018 Apr;48:14-27. doi: 10.1016/j.bpobgyn.2017.08.014. Epub 2017 Sep 5. PMID: 28927766.
Bacon JL, Romano ME, Quint EH. Clinical Recommendation: Labial Adhesions. J Pediatr Adolesc Gynecol. 2015 Oct;28(5):405-9. doi: 10.1016/j.jpag.2015.04.010. Epub 2015 Apr 24. PMID: 26162697.