labial adhesions

[gardenmommy]

At our latest well-child visit (two days ago), the Dr. mentioned that DD (19 months) has fused labia minora.  She said that I need to gently apply a cream (like vaseline or something safe for the diaper area) and traction them apart.  That seemed odd to me, so I asked specifically if I should just leave it be, similarly to not retracting an intact penis.  She said, no, it's important to open the labia, and if I can't get them open and keep them open, she would have to refer to a urologist for further intervention.  She said there will likely be some minor bleeding and pain, which just seemed a bit off to me.  So, I didn't follow my intuition and do more research on the matter.  Instead, today, I followed her advice, and tried to gently separate them.  DD was obviously uncomfortable, and didn't like it *at all*.  A few hours later, she began crying inconsolably, communicating that her bottom was hurting.  I looked at her, and her labia are quite red and painful-looking.  I applied calendula cream, which seemed to ease the discomfort.  I am very unhappy with myself; I regret ever messing with her girl parts, and wish I'd just followed my intuition on the whole thing.

I've been doing some research on the topic, and am coming up with some conflicting advice.  Some say to leave it alone, that labial adhesions will generally self-correct, others say to use an estrogen cream, others say to gently traction it open.  If you have experience with this, how did you resolve it?

[lovepickles]

I'm so sorry. My niece had this issue and I remember seeing my sister apply the cream (I think it was some sort of steroid)  to prevent the same issue. I hated it and thought it was awful. But that was over 13 years ago. I need to make it clear that I disagree with majority of her parenting choices.

Causing pain in that area is not acceptable as a treatment option. Please get a second or third opinion.

Also, forgive yourself and talk to your daughter about it in very simple words. Stop feeling guilty for doing what you thought was right. But pay attention to your reaction to her pain because it is telling you something.

[gardenmommy]

Thanks for replying!  DD is doing much better now.  I am going to let it alone right now until I can find a new Dr. (for more reasons than this).  I am definitely going to get another opinion.  She seems to have no problem urinating, so I think it's fine to leave it for now.  I just think that there needs to be a *really* good reason for causing pain to a child for any reason, but especially so to that area.   

[sassyfirechick]

Just came across this, my DD was 'diagnosed' with this also at her last well baby (9mos) 2 wks ago, and my pedi gave me 2 options: estrogen cream, or leave it be and by the time she's out of diapers getting more air flow things should self correct.  She said she already knew I'd pick the latter and didn't see it being an issue unless she started having UTI's.  Curious what ended up happening for your LO?

[gardenmommy]

Well, we are taking the "wait and see" approach.  So far, DD seems to be fine.  No UTIs or trouble urinating, no pain, etc.  I haven't checked it in awhile, because she really doesn't like me to mess with her girls bits unless absolutely necessary.  I think that Dr. visit really left her feeling gun-shy about anyone touching her there.  She is even testy about me cleaning her after a poopy diaper.  She is close to being out of diapers, so I think it may completely resolve itself then.  Thanks for asking!

[Fly Girl]

My DD2 had this too. Her Dr. pointed it out at our first checkup when she was a week old. We were also told that we could apply an estrogen cream or just vaseline but were not told to traction it apart. I didn't do anything about it for awhile. Just kept an eye on it. But one diaper change I noticed that her labia had fused even more all the way down covering her vagina. At that point I decided to do something. I took a vaseline like cream with a q-tip and applied it to her labia with just a little pressure. I did NOT try to pull her labia apart and it did not hurt her a bit. I did that every day and about 2 weeks later it came apart. She's never had any issues since then.
 

[pattimomma]

My DD had this problem as an infant. We used the estrogen cream and it worked like a charm. My pediatrician explained it as a common problem for babies and old ladies. Sure enough I noticed the exact same prescription cream in my mom's bathroom! At least I will know what to expect if it happens to me after menopause! LOL
 

[gardenmommy]

Interesting!  I really need to check DD again.  She is just very much opposed to my doing anything in that area.  She will tolerate it if I explain what I need to do, and reassure her that I will be very gentle.

[ommom108]

hi everyone

i felt i wanted to come to the forums and post what happened with us b/c i remember when i searched for info. on what happened to girls with labial adhesion, i'd always find dialogue from people in the midst of it but never from someone who had passed it or was older. 

our daughter will be 4 years old this month. 

she had partial labial adhesion in the middle section that did not block urine & left a tiny opening at the bottom for her vagina.

we opted to NOT use cream since she didn't have UTIs and to just wait and see.

sometimes i'd worry 'cuz she'd mention being ow-y at her butt but i realized it happened usually after she was racing around on her trike or balance bike so maybe that area is more sensitive to pressure that way when the labia are still adhered. she never cried or had pain while urinating. 

this month when wiping her i realized she had fully opened up! 

i was VERY glad to see that and just wanted to share our instance with others. 

the timing of it (may be totally random or not) is also pretty much the same month we are (i think) weaned.

best wishes, 

om mom 108

[~Nikki~]

My daughter had this as a baby and we used the estrogen cream.  Applied it daily and very very gently applied pressure so as not to cause pain.  It didn't take long (maybe a couple of weeks?) and it separated.  It didn't cause any pain (that she expressed), no bleeding, tearing, etc.  I've heard it's common, too, but don't know anyone else in "real life" that's dealt with it. ;)

[gardenmommy]

ommom108, that is interesting, because DD is nearly weaned, and has pretty much lost the adhesion.  I haven't heard her complaining about pain, but I do try to be extra gentle with her when I wipe her bottom.  She is still pretty gunshy about anyone touching her there (and I'm almost exclusively the only one who changes her diapers), so I mess around as little as possible.  I wonder if nursing has anything to do with adhesions?  That is very interesting.

[sassyfirechick]

Good to know!  DD is 13mos, she's slowly dwindling on her nursing (much to mommy's dismay!) and is down to about 3-4x a day, maybe a bit more if her teeth bother her but not so much for eating purposes, just comfort.  I haven't noticed anything looking more closed, she expresses no indication of pain or discomfort, hasn't had any UTI's.  We do have her 1yr wellness in a wk so I'm sure the pedi will go poking around and I'll watch how DD reacts - I leave it be, so I'm not sure how she will feel if the pedi starts pulling at things but I'll certainly tell her to stop if it bothers my baby!  I had asked my midwife at one point if she thought it was related to the mom having low estrogen while nursing thus not passing on any to baby to open things up but she really didn't know much about it. 

[sassyfirechick]

Ok, finally got around to the 1yr well baby, and everything is open :-) 

[nia82]

DD had it at 18 months. She was fine before, but started "butt scooting" at 11 months and that must have aggravated her skin and caused it to fuse. She was closed up completely. I didn't notice cause she is my first girl and I never felt like it was necessary to wipe a lot so I didn't look much at it (I removed poop, but not smegma, as that's unhealthy to wipe away). At any rate, we opted for the estrogen cream. I only used it for less than a week I think and she opened up. NO traction or pain, and our doctor never mentioned that. That seems old-fashioned and dangerous advice.

[blackbird2]

A doctor noticed what she called thick labial adhesion at my DD's 1 yr check up.  She had a grain-of-rice sized hole at the bottom and a smaller one at the top.  She recommended estrogen cream.   We opted to wait a little and talk with a doctor we had a better relationship with.  DD had no discomfort or UTIs.  Within a month we could see significant change (opening), and when we saw our usual doctor at 15 months her labia were much more open (about 1cm in length?).  Everything looks healthy, so we're going to keep waiting.

The statistic I remember are that 80% of these cases resolve themselves within one year.  My DS's foreskin didn't retract fully until he was between 3 and 4 yrs old.  I don't think this is a topic that most american doctors are very comfortable with, and I think it would be much easier to treat a 4 yr old who can have a clear understanding of what's going on and why.  Those are the thoughts that also influenced my decision.