Irritations of the vulva—the external female genitalia—are common in infant and preschool girls. Wet and soiled diapers, detergent residues in diapers and underpants, and all kinds of soap (particularly bubble bath) can cause redness, itching and inflammation in this sensitive area.

Labial adhesions are common in girls in the first few years of life but also occur in older children. The labia minora (the pinkish inner lips of the vulva) become fused together during the process of healing following vulvar irritation. The result looks like a malformation of the genitals: When the labia majora (the larger, outer lips of the vulva) are spread apart, a solid membrane is visible, completely covering the vaginal opening. There may be a small urinary opening at the upper end of the membrane, but the inner sides of the labia are not visible. It also may be possible to see a thin line running down the middle of the membrane where the edges of the labia met.

HOW DO LABIAL ADHESIONS DEVELOP?
Irritation that may be minor enough to go unnoticed generally precedes the development of labial adhesions. As the irritation heals, new cells on the edges of both labia minora stick to each other as if they were part of the same structure. In a short time, the two labia are fused into a single membrane. The cause is unknown.

Once labial adhesions develop, urine buildup behind the membrane may lead to further irritation, creating a kind of vicious cycle in which inflammation never subsides completely and the labia remain fused.

WHEN SHOULD I SUSPECT THAT MY DAUGHTER HAS LABIAL ADHESIONS?
A quick visual inspection of the vulva during a diaper change should alert you to the presence of labial adhesions. Pediatricians generally perform such examinations during routine checkups as well.

Most of the time, adhesions themselves produce no symptoms. In some cases, there may be discomfort and difficulty urinating. If the adhesions are causing soreness, the child may rub the vulva excessively.

HOW ARE LABIAL ADHESIONS TREATED?
No treatment is necessary unless the adhesions are associated with repeated urinary tract infections and pain on urination.

If the adhesions require treatment, the pediatrician will prescribe an estrogen cream to be applied to the labia. This treatment, which usually continues for about a month, resolves almost all adhesions, although continued application of petroleum jelly may be necessary to keep the labia from fusing again. It is not advisable to separate the labia forcefully or with surgery, since the trauma of these procedures often leads to further irritation and repeated formation of adhesions.

ARE GIRLS WITH LABIAL ADHESIONS AT RISK OF OTHER GENITAL OR URINARY-TRACT ABNORMALITIES?
Not at all. Unfortunately, though, many parents are so distressed by the abnormal appearance of labial adhesions that they insist on treatment. While the treatment is also harmless, all the fuss may place an undue focus for the child and her family on her genitalia.

Severe labial adhesions that obstruct the flow of urine can lead to urinary tract infections, which require antibiotic treatment. If the pediatrician diagnoses such an infection in a girl with labial adhesions, both conditions will probably be treated.

GETTING HELP
Call your doctor if:

• You notice anything unusual about your baby's genitals

• Your baby cries when urinating

• Your child complains of pain, burning or itching in the genital area

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.