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

Disclosures

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

In This Article

Discussion

Optimal care of the perineum after delivery has been debated and researched, and practices have varied widely over the years and from institution to institution.[12] Modern instructions for care of the postpartum perineum often include encouraging women to separate the labia with urination and periodically cleansing the perineum with a peri-bottle or sitz bath. These recommendations may be especially important for women with unrepaired labial lacerations to prevent the formation of tissue bridges from one labia to another.[5,11]

Topical estrogen cream is a common therapy for childhood or postmenopausal labial adhesions. These adhesions are very superficial and are the result of mild irritation of the vaginal mucus membranes and subsequent repair. Estrogen for several days to a few weeks, along with gentle massage, is often enough to disrupt adhesions in these groups and surgical treatment is reserved for refractory cases.[3]

A brief trial of estrogen cream was used unsuccessfully on 3 of the previously described postpartum labial adhesions.[1,3,5] Several previous authors hypothesized that the relative hypoestrogenic state of the immediate postpartum period contributes to the formation of labial adhesions.[1,3,8] However, this theory is not supported given that topical estrogen has failed to treat postpartum adhesions. The postpartum adhesions that have been described have all been tissue bridges or bands rather than thin membranes. The labia naturally come in close contact to one another when the legs are in the adducted position. When one or both labia have an open wound, growth of a tissue bridge across the labia can occur as a by-product of normal healing of the wound.

Most of the previously described adhesions were a few millimeters to several centimeters wide. Surgical dissection was the definitive therapy in every reported case. This approach has the advantage that the procedure is brief and healing occurs rapidly versus the days to weeks required for topical estrogen to be effective. Injection of local agent provides adequate anesthesia to labial tissue, and using epinephrine helps decrease bleeding after division. Rarely, extensive adhesions may require general anesthesia.

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