The synechia of the labia ( lat. Synechiae labiorum minorum ), sometimes referred to as the synechia of the vulva ( lat. Synechia vulvae [1] ; from the Greek. Synecheia - continuity, connection) - is the union of large or small labia in their lower third or all along. The labia are at the same time connected to each other by a very thin membrane, the entrance to the vagina is absent, and when fully closed, the opening of the urethra is blocked [2] .
| Labia synechiae lat synechia vulvae lat synechiae labiorum minorum | |
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| ICD-10 | |
| eMedicine | article / 953412 |
Content
Reasons to
The cause of synechia is most often the inflammatory process in the external genital and vaginal organs ( vulvitis , vulvovaginitis ), as well as allergic reactions , improper hygiene of girls' genitals. Synechiae can be formed in a few days, or within a few months. The process of formation of synechiae does not inflict pain on the child, and therefore often goes unnoticed [3] .
In some cases, the labia minoras grow together above the entrance to the urethra, making it difficult to urinate and causing discomfort to the girl. Often the girl's parents do not notice this problem in her or do not attach any importance to this, so the disease is often detected only during examinations by a teen gynecologist [1] [4] .
The reason may also be repeated washing during the day, especially with soap. The mucous membrane of the vulva (external genital organs) in a little girl is very thin and, when exposed to soap, can easily be injured with strong friction, and as a result of further healing, the lips of the labia minora synechia are fused [3] .
A second cause of synechiae may be a urinary tract infection. Dangerous bacteria fall on the mucous membrane of the external genital organs, inflammation develops, which leads to fusion [5] .
The formation of synechia with low content of sex hormones ( estrogens ) in girls of this age is explained [3] .
The probability of formation of synechia decreases after 6-8 years of age. In addition to the level of the hormone, a possible cause is food allergy to certain foods or hygiene products, synthetic clothing [2] [3] .
The absence of sex hormones in young children is not a pathology, but the norm. Therefore, the older the child becomes, the less likely it is to re-grow. This is because when the girl matures, the mucous membrane of the labia becomes more dense, the subcutaneous layer thickens, the external genitals become less sensitive to stimuli from the outside and therefore do not grow together [4] .
The main role of estrogen is confirmed by clinical observations, which showed that synechiae do not occur in newborn girls, when the level of maternal estrogen is high in the child’s blood. By the time of puberty , when the girl’s own estrogen level rises, at least 80% of even the most severe cases are resolved independently and without a trace [4] .
Main symptoms
Doctors diagnose synechia when a small girl has small labia “stick together” with each other. The entrance to the vagina is covered with a film. The synechiae look like a film with a median, clearly visible strip (center of fusion) formed in the center between the labia minora lips. With complete synechia, even the urethral opening is not visible. In this case, there are difficulties when urinating: the child is straining, experiencing discomfort, capriciousness, crying, and this is observed during almost every act [3] [1] .
It happens that small and large labia intergrow together, usually symmetrically on both sides. The labia lips often grow together, closing the entrance to the vagina a few millimeters, 1/3, half, or even completely [1] [3] .
Treatment
In the early stages (when the labia have not yet “stuck together” completely), the situation can be corrected quite easily. Enough for the night to impose a gasket on the labia with ointment containing estrogen . The procedure should be carried out within 5-7 days [6] [7] .
In case the disease is neglected, surgical separation of the labia minora is performed. The operation is performed under local anesthesia [3] . After surgical separation of synechiae, the risk of recurrence is approximately 30% [8] , the doctor may decide on the use of estrogens after the intervention [9] .
Notes
- 2 1 2 3 4 Fleisher, Gary R. Textbook of Pediatric Emergency Medicine / Gary R. Fleisher, Stephen Ludwig. - Lippincott Williams & Wilkins , 2010. - P. 842. - ISBN 9781605471594 .
- ↑ 1 2 NHS Direct Wales - Encyclopedia: Labial fusion . NHS Direct Wales. The appeal date is September 13, 2011.
- 2 1 2 3 4 5 6 7 Broecker, Jane ED Imperforate hymen // The 5-minute Obstetrics and Gynecology Consult. - Lippincott Williams & Wilkins , 2008. - P. 122–123. - ISBN 9780781769426 .
- 2 1 2 3 Zitelli, Basil J. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis / Basil J. Zitelli, Sara C. McIntire, Andrew J. Nowalk. - Elsevier , 2012. - P. 580. - ISBN 9780323091589 .
- ↑ Smith, Roger Perry. Netter's Obstetrics and Gynecology. - Elsevier , 2008. - P. 202. - ISBN 9781416056829 .
- ↑ Belman, A. Barry. Clinical Pediatric Urology / A. Barry Belman, Lowell R. King, Stephen A. Kramer. - CRC Press , 2001. - P. 219–220. - ISBN 9781901865639 .
- ↑ Creighton, Sarah. Pediatric and adolescent gynecology // Pediatric Surgery. - 2nd. - CRC Press , 2005. - P. 555–556. - ISBN 9780340809105 .
- ↑ Baskin, Laurence. Genitourinary Tumors // Clinical Problems in Pediatric Urology / Laurence Baskin, Hubert S. Swana. - John Wiley & Sons , 2008. - P. 175–176. - ISBN 9781405171854 .
- ↑ Mayoglou, Lazarus; Dulabon, Lori; Martin-Alguacil, Nieves; Pfaff, Donald; Schober, Justine. Successful Treatment for Auspicious and Surgical Treatments (Eng.) // Journal of Pediatric and Adolescent Gynecology : journal. - 2009. - August ( vol. 22 , no. 4 ). - P. 247-250 . - DOI : 10.1016 / j.jpag.2008.09.003 .
Literature
- Pediatric gynecology. - Medical Information Agency, 2007. - 480 p. - ISBN 5-89481-497-9 .
Links
- Sexual lips of girls can grow together . dobrenok.com . Encyclopedia. Health. Medicine .. Date of treatment is June 16, 2018.