Parents sometimes note when changing a nappy that their child’s vagina appears to be partially closed, a condition called labial adhesions. This happens when the labia majora partially fuse in the middle. Labial adhesions are not uncommon in baby and toddler girls and are not usually cause for concern. They usually form from the side closest to the anus and progress upward toward the abdomen. Rarely do they cover the entire vaginal opening or interfere with urination. Unless there is other nappy rash irritation, they are not usually uncomfortable or painful.
Labial adhesions are thought to be due to the low oestrogen level found in baby girls. In fact, labial adhesions in older girls often resolve spontaneously during puberty as oestrogen levels naturally increase. Vaginal irritation is a risk factor for developing adhesions.
Treatment is not necessary if the adhesions are very mild, there is no discomfort or problem voiding if and there is not irritation of the surrounding tissues. A topical oestrogen cream is the treatment of choice when indicated. A very thin layer of cream is applied over the adhesion 2-3 times a day for a few weeks. Once the labia separate, it is important to use a topical emollient to the area to prevent recurrence.
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