Synechia of the labia - symptoms and treatment
Synechiae of the labia minora, the clinical course of which is not accompanied by significant symptoms, often do not require treatment, since they can go away on their own [1][2].
For example, asymptomatic synechiae with a height of less than 5 mm are subject to dynamic monitoring : parents monitor the course of the disease independently, the frequency of visits to the pediatric gynecologist is determined individually [1][2]. In case of a pronounced increase in the height of synechiae and/or when complaints occur, drug therapy .
The “gold standard” of conservative treatment is the administration of ointments with conjugated estrogen or estriol. These drugs are the first line of therapy. The mechanism of their action is to increase the number of glandular cells and epithelial cells, enhancing recovery under the influence of exogenous estrogen.
The ointment is prescribed in a course and applied topically once a day. Side effects may include hyperpigmentation of the vulva, rash, engorgement of the mammary glands and bloody discharge from the genital tract. These side effects require discontinuation of drugs.
It is preferable to use ointments containing estriol. They may also cause hormone-related side effects, but the risk of these has been shown to be lower than with conjugated estrogens [1][2].
Abroad, ointments containing topical steroids (for example, betamethasone) are actively used. This group of drugs also demonstrates a good clinical response in patients. The combined use of topical steroids with estrogen-containing drugs is possible [2].
The ineffectiveness of herbal baths, antibacterial ointments (with the exception of vulvovaginitis with an identified pathogen), applications with animal fats, and enzymatic agents has been proven [2].
It has been noted that the earlier conservative therapy for synechiae is started (i.e. at a younger age), the higher the frequency of a pronounced therapeutic response, but the higher the frequency of relapses [2].
Recurrent formation of synechiae with conservative treatment occurs in 41% of cases [3]. The reason for the relapse of the disease is unresolved chronic inflammation, which caused the formation of synechiae. Eliminating it is not such an easy task.
The surgical method of treatment is mechanical or instrumental separation of the labia minora [2]. Indications for dissection of synechiae are:
- complete fusion of the labia minora;
- the presence of pronounced signs of impaired urine outflow;
- the presence of a persistent recurrent course of synechiae;
- ineffectiveness of conservative therapy.
The operation is performed on an outpatient basis. 5-10 minutes before the procedure, topical anesthesia using an ointment containing lidocaine is used for pain relief. Sometimes surgery is preceded by the administration of sedatives to calm the child. During the operation, the doctor spreads the labia majora in opposite directions and cuts the connecting membrane with a scalpel or scissors. A grooved probe is inserted into the formed hole, along the groove of which the connective tissue membrane is completely dissected with a scalpel.
Some authors suggest applying continuous upholstery sutures to the wound surface of the labia minora to prevent recurrence [3]. It is believed that this method can reduce the frequency of recurrence of synechiae to 17% [3].
In the presence of “fresh” thin synechiae, mechanical separation of the labia minora in opposite directions without the use of cutting instruments is often sufficient: under the influence of tension, the connective tissue bridges are torn without causing pain.
Parents can eliminate “fresh” synechiae on their own without seeing a doctor. To do this, it is recommended to separate the labia with cotton swabs and emollients. Most often this method is effective.
To reduce the risk of relapse, it is recommended to apply ointment with conjugated estrogen or estriol to the wound surface before healing. As a rule, after manipulation, children do not complain of pain, but sometimes they may feel discomfort during urination during the first two days.
The relapse rate during surgical dissection of synechiae of the labia minora reaches 50%, therefore, it is not advisable to use surgical treatment tactics as the first line of therapy [1][2][3].
The high frequency of relapses in the treatment of synechiae of the labia minora dictates the need to search for alternative methods of therapy.
The possibilities of using gels with hyaluronic acid are now being actively studied, since it is involved in tissue healing and improves their trophism. The advantage of such gels is their low allergenic potential, immune neutrality and the absence of systemic side effects. Studies have demonstrated a good therapeutic response when using gels with hyaluronic acid as monotherapy and in combination with surgical dissection of synechiae [8][9][10][11]. The study of this group of drugs is a promising direction in the development of new methods for treating synechia of the labia minora.
First days
As soon as the girl is born, she is examined by a doctor. Normally, the baby should have 2 labia minora and 2 labia majora, a free entrance to the vagina, the presence of a hymen and an opening in it - for the release of menstrual flow in the future. On the first day, the child may have bloody discharge from the vagina. It’s the mother’s hormonal background that’s acting – and soon everything goes away.
Important! Sometimes a girl is born with an overgrown hymen. However, surgery is rarely required.
8-9 years
The mammary glands gradually form, single hard hairs appear on the pubis, and the waist is indicated. The child quickly reaches up. All this suggests that the young lady’s sex secretion glands have begun to work.
Important! Breasts, of course, don't appear overnight. First, these are small seals. Normally, they do not hurt, but the girl may complain of discomfort when touched. Also, the mammary glands never grow at the same time, so for some time one breast may be smaller than the other.
Preventive actions
Prevention of synechiae in girls includes the following measures:
- Adequate care. After defecation, the child is washed with a neutral agent, and the rest of the time with clean warm water. Moisture from the genitals is removed with a soft, clean towel without rubbing.
- Regular air baths. It is important to ensure frequent contact of intimate areas with air. It is enough to let the baby walk naked after each wash.
- Timely response to inflammation. If you notice diaper rash, peeling, rash or redness of the genital mucosa, you should consult a doctor.
- Eliminating allergens. If you are hypersensitive to food or chemical allergens, contact with them should be completely avoided.
Synechiae can form over several months or within a few days. In order to identify the problem in time, it is necessary to pay attention to the condition of the child’s genitals every day.
12-15 years
It is during these years, on average, that menstruation begins. The first two years the cycle begins to develop - menstruation may be absent for 2-3 months. Then the cycle should be stable - 24-35 days.
Important! If you have pain, dizziness, nausea, you need to consult a gynecologist. During the transition period, it is important to ensure that the young lady gets enough sleep and eats normally - diets can lead to hormonal imbalance, menstrual cycle disruptions and other negative health consequences.
Breeding synechiae in girls
IMPORTANT: The earlier synechiae are detected, the easier it is to breed them. At the very beginning of the disease, the film is thin and transparent. And when fully fused, it becomes dense, the body perceives the genital gap as a wound, and without surgical intervention it cannot be separated.
- You cannot do this on your own; you can only harm the child. If you suspect synechia, you should seek help from a pediatric gynecologist.
- It is believed that synechiae should not be touched at the initial stage, but should be diluted only when the fusion brings discomfort to the baby
Treatment of synechiae, dissection of synechiae in girls
- The dissection of synechiae in girls is done by a pediatric gynecologist. This procedure is performed using a scalpel and takes a few seconds. The manipulation is painful and requires special care for the baby’s genitals
- To relieve painful urination and wound healing, sitz baths, lotions and antibacterial ointments are recommended
IMPORTANT: Dissection does not protect against repeated relapses. The labia minora may grow back together. Parents have the right to refuse this method of treatment, but with complete fusion, when urination is impaired, this is the only way to help the girl.
Reasons for the formation of synechiae
In infancy, the problem of synechiae rarely occurs, since a certain amount of estrogens from the mother is still present in the baby’s body. Over time, the hormone is destroyed.
Low estrogen levels for little girls are physiologically normal. However, this is precisely what determines the high sensitivity of the mucous membranes of intimate areas and the tendency to form adhesions under the influence of provoking factors. The causes of vulvar synechia in girls can be:
- infectious and inflammatory diseases of the urinary system or genital organs (vulvitis, vulvovaginitis, urethritis, cystitis);
- overly active intimate hygiene;
- mucosal injuries;
- use of aggressive detergents for washing;
- insufficient genital hygiene;
- regular contact with allergens (food, household);
- complications during pregnancy or childbirth;
- abuse of diapers (as a result, overheating of the genitals and lack of contact with air).
As a girl gets older, the level of female hormones in a girl increases, which thickens the mucous membrane of the genital organs and reduces its sensitivity to irritants.
Synechiae in girls looks like a thin film between the labia minora and/or labia majora with a clearly visible midline. Partial (⅓, half) or complete fusion is possible. The film is capable of covering the opening of the urethra. In this case, miction becomes difficult. The girl has to push to empty her bladder. Due to the discomfort, it is difficult to sit the child on the potty.
Keep calm
The girl should be shown to the gynecologist at each of her significant periods - before entering kindergarten, before school, with the arrival of her first menstruation - for the purpose of prevention.
The “First Gynecologist” program is designed specifically for young ladies – girls entering puberty.
The package includes:
- initial and repeated consultations with an obstetrician-gynecologist;
- inspection;
- bacterioscopic examination of urogenital secretions;
- bacteriological examination of urogenital secretions with determination of sensitivity to antibiotics;
- Ultrasound of the pelvic organs.
How to conduct an inspection
Before the examination, wash your hands thoroughly with soap and water and trim your nails so as not to injure the delicate skin. While spreading the baby's legs, carefully examine the genitals. This highlights the presence of a genital fissure through which the vagina can be seen.
If instead of a crack, only a whitish stripe is visible, and attempts to part the labia do not yield results, there is a high probability of synechiae. In rare cases, the labia majora also become fused.
Formula for ideal female genitals
It’s not difficult to understand whether everything is normal in your intimate area. If all is well, the following conditions are met:
- Nothing gets in the way;
- Nothing irritates;
- Nothing hurts;
- The skin is clean, smooth, without ulcers, acne or scratching;
- There are no problems during sexual intercourse.
If any condition is not met or something bothers you, contact our Intimate Plastic Center. Our gynecologists know how to correct any defect in this area.
You can view the results of the work of gynecological surgeons in the section “Photos before and after intimate plastic surgery.”
