Dean A. Seehusen, MD, MPH; J. Scott Earwood, MD

Disclosures

J Am Board Fam Med. 2007;20(4):408-410. 

In This Article

Case

A 29-year-old woman, primigravida, underwent scheduled induction of labor at 41 2/7 weeks. She received prostaglandin E2 for induction. An effective epidural was placed, and she progressed full to effacement and dilation. She pushed for 150 minutes and, because of maternal exhaustion, required uncomplicated vacuum assistance. A second-degree midline laceration was repaired in the usual fashion. In addition, superficial lacerations extending the entire length of both labia minora were noted with good hemostasis and were not repaired. She was instructed in standard perineal care, which included spreading the labia periodically and washing with water. The patient was discharged 48 hours after delivery with no complications and instructed to continue sitz baths and routine perineal hygiene at home.

At her scheduled 6-week postpartum examination, the patient stated that she and her husband had noticed that her vaginal area "did not look like it had healed right." They were unable to resume sexual activity secondary to inability to achieve penile insertion. She denied pain, vaginal discharge, or difficulty urinating. She was breastfeeding and taking no medications. A 5-mm tissue bridge connecting the right and left labia minora was observed (see Figure 1).

Figure 1.

Labial adhesion before dissection.

On the same day, the tissue bridge was injected with 1% lidocaine containing epinephrine and was divided with iris scissors. The patient tolerated the procedure well and was discharged from the hospital with instructions to separate the labia periodically to prevent reanastomosis. Three days later she was seen in follow-up. She had resumed sexual activity and was pain free. Examination revealed that her labia were completely healed (see Figure 2).

Figure 2.

Well-healed labia 3 days later.

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