Postpartum Labial Adhesions

In This Article

Abstract and Introduction

Abstract

Background: Labial adhesions are common in young girls and menopausal women. Topical estrogen is the first line of therapy for these adhesions. Based on a systematic literature review, postpartum labial adhesions are uncommon in clinical practice. They are not painful but can prevent patients from resuming normal sexual activity. Topical estrogen therapy is an ineffective treatment option for adhesions in this setting. Surgical division under local anesthesia is usually effective.
Case: A 29-year-old women presented at 6 weeks after an uncomplicated vacuum-assisted delivery for a routine postpartum evaluation. Examination revealed a 5-mm labial adhesion connecting her left and right labia minora. Division under local anesthetic resulted in a complete recovery within 3 days.
Conclusion: Postpartum labial adhesions can usually be surgically divided under local anesthetic with complete and rapid recovery.

Introduction

Labial adhesions are common in young girls and occasionally occur in elderly women.^[1] It is hypothesized that the relative hypoestrogenic states of these age groups predispose them to labial adhesions.^[2] Although surgical dissection is sometimes required, topical estrogen creams and gentle massage usually lead to successful breakdown of adhesions in these groups within a few weeks.^[3] Labial adhesions have also been described in reproductive age women secondary to female circumcision, lichen sclerosis, herpes simplex, diabetes, pemphigoid, and caustic vaginitis.^[3,4,5,6,7] Postpartum labial adhesions are rarely described in the medical literature.

Cite this: Postpartum Labial Adhesions - Medscape - Jul 01, 2007.

Table 1. Summary of Reported Cases of Postpartum Labial Adhesions
Author	Delivery	Perineal trauma with Delivery	Initial Therapy	Definitive Therapy
Shaver et al (1986)^[1]	SVD	Vaginal sidewall	Topical estrogen	Surgery with local anesthetic
Davenport and Richardson (1986)^[8]	SVD	Episiotomy; massive vulvar edema	Surgery with general anesthesia	Surgery with general anesthesia
Davenport and Richardson (1986)^[8]	SVD	Labial; massive vulvar edema	Surgery with local anesthetic	Surgery with local anesthetic
Yoong and Alderman (1990)^[9]	SVD	Superficial	Surgery with general anesthesia	Surgery with general anesthesia
Greaves et al (1998)^[4]	Vacuum-assisted delivery	Episiotomy; ferric subsulfate	Surgery with general anesthesia	Surgery with general anesthesia
Arkin and Chern-Hughes (2001)^[5]	SVD	"Skid marks"	Topical estrogen	Surgery with local anesthetic
Steele and Lowry (2002)^[10]	SVD	Labial	Digital separation	Surgery with general anesthesia
Lin et al (2002)^[3]	SVD	Massive vulvar edema	Topical estrogen	Amniotic membrane graft
Sharma et al (2005)^[11]	SVD	Second degree	Surgery with local anesthetic	Surgery with local anesthetic
Seehusen and Earwood (this paper)	Vacuum-assisted delivery	Second degree; labial	Surgery with local anesthetic	Surgery with local anesthetic

SVD = spontaneous vaginal delivery.

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Postpartum Labial Adhesions

Abstract and Introduction

Abstract

Introduction

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References

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Authors and Disclosures

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