Friday, July 29, 2011

Let's Talk About Labial Adhesions

I know what you're thinking.  What the heck is a "labial adhesion"?!  It's when the labia minora stick (fuse) together.  It's identified by a white line down the center of what looks like a membrane that covers the opening of the child's vaginal opening, and shows that the two sides have adhered to one another.

Labial adhesion occur most commonly in girls who are between 3 months to 6 years of age; these adhesion can persist until puberty. Some children with labial adhesion will have no symptoms, while other girls may have pain in the genital area, difficulty urinating, or frequent urinary tract (bladder) infections.

It's estimated that up to 10 to 20 percent of girls have these labial adhesion at some time in their first six years of life. For most girls, these adhesion resolve on their own in six to twelve months, without any treatment.
I never even knew there was such a thing until my baby girl developed this around 4 months old.  I took her in for a well-baby check-up, and the Dr. noticed it.  He told me that he was going to prescribe a hormone cream to put on it, and that when combined with "gently pulling the two sides apart", this could be "cured" within a few weeks.  He told me that after it separated, I should be putting Vaseline along the folds of her vagina to keep the two sides from fusing again.

My daughter's vagina had almost completely closed up, leaving only a pin-hole size opening at the top.  Urine had still been passing, so I never noticed anything wrong with her.  (I don't look THAT close when I wipe her, so if my Dr. hadn't noticed, I never would have known.)

At the time I was kind of blind-sided, so I just stood there thinking about how every word he said seemed to be exactly what I have heard Dr.'s say about circumcising boys.  "Something needs to be done to prevent a possibility of problems in the future"..."if it fuses back together in the future, it could close right up and require her have her labia cut apart"..."gently pull the two pieces of skin apart, and when it has been done, put Vaseline there to keep it from healing together again".  My inner intactivist was screaming the whole time.

Even in what was very close to a state of shock (How had I not noticed?!  Is there going to be something wrong with this perfect baby too?!), all I could think was that I trusted him with my son's genitals, and he proved to me that he was not to be trusted.  Here I was again, two years later, standing in his office doubting that he knew what he was talking about. 

As we left, I had to tell my husband that he just seemed too eager to have me fiddle with her privates...exactly like when my son was an infant and he told me to "gently retract the foreskin" of his penis.  I listened to him back then.  I wasn't going to make the same mistake again.  So I looked into it further, and asked around. 

Thankfully I found someone who had 3 daughters who all had the same thing occur, and who had it happen to her when she was an infant as well.  She sent me some links that explained that the reason it happens can be anything from irritation from diapers (when they're older) to hormones from mom exiting the baby's body (as I'm sure was the case with my 4 month old), and that it can fix itself without the use of hormone creams.  When girls start making their own hormones, it completely fixes itself on it's own.

"The adhesion will often resolve spontaneously when girls are out of diapers or pull-ups both day and night. When labial adhesion persist, the estrogen surge at puberty will correct the problem."
That was found HERE.

Since hormone creams are made from the urine of pregnant horses, it's probably not a great idea to jump on that wagon unless you have no other choice.  (And I mean for REAL have no other choice.  Not just because your Dr. scared you into believing that it had to be done even though it's not completely closed up.)
"If there are no complications, such as infections or obstruction, the adhesion do not need to be treated.

Never attempt to separate the labia forcefully. This is painful and traumatic. Moreover, it usually results in even worse adhesion than before." 

"If you do use an estrogen cream, you should be aware that some girls will have other transient estrogen effects, including increased breast tissue and darkening of the labia and/or nipples. These resolve when the estrogen applications stop. Stopping the estrogen also sometimes causes a brief 'mini-period,' or vaginal bleeding."

Again, that was found HERE.

So, although there are surely cases that have gone so far that the labia has completely closed up and is blocking the flow of urine and would actually need some intervention, it is a last resort.  We live in a society of cutters, so we need to be educated and informed of the facts BEFORE we're faced with this situation.
My daughter's labia is almost completely separated now, simply by giving it a couple of extra wipes at diaper changes.  It's just hanging on by a tiny thread of skin.  No cream.  No tugging at it.  Just wiping.  So, it can be done.  If it had closed up more, and I had been wrong to question my Dr., I could have used the cream.  But I didn't need to.  And because I am now aware of it, I can keep an eye on it and prevent it from closing back up. 

Sadly, if you want to research this, you're going to have to swim through an ocean of mis-information.  The AAP suggests the Dr. tug the two sides apart, and the parents keep Vaseline on the raw skin to keep it from healing back up.  (No mention that it can cure itself, or that the irritation of it being torn apart causes more irritation which can cause it to fuse again...)

Anyways, that's that.  It's normal.  It happens.  And it is not a big deal unless your child is unable to pass urine. 

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