Mert Küçük, Selda Demircan Sezer, Sümeyra Nergiz Avcıoğlu, Sündüz Özlem Altınkaya, Hasan Yüksel, Emre Zafer

Labial Adhesion in Adulthood: A Report of Two Cases

Erişkinlerde nadir görülen ve değişik sebeplere bağlı olabilen labial adezyonlarla özellikle premenarş ve postmenapozal dönemde karşılaşılmaktadır. Burada, farklı nedenle oluşan iki erişkin labial füzyon olgusu takdim edilmiştir. Olgu- 1: İdrar yapamama şikayetiyle acil servise başvuran 38 yaşındaki virgo kadının muayenesinde labiumların periüretral alanı da içerecek şekilde tamamen kapattığı görüldü. Anamnezinde, hastanın mental retarde olduğu ve primer amenoresi olduğu öğrenildi. Genel vücut bakımı vasat olan hastanın yapılan muayenesinde meme gelişimi ve pubik kıllanma gibi sekonder seks karakter gelişiminin Tanner Evre- 5 olduğu gözlendi. Olgu 1’in tedavisinde, cerrahi olarak labiumlar dışa devrilerek introital açıklığın devamlılığı sağlandı. İşlem sonrasında östrojenli krem verildi. Olgu-2: Daha önce Behçet hastalığı tanısı alan, yaklaşık bir aydır idrar yaparken zorlanma, yanma yakınmasıyla konsülte edilen 42 yaşındaki hastanın anamnezinde iki normal doğum yaptığı öğrenildi. Hastanın yapılan pelvik muayenesinde labiumlarda Behçet hastalığı ile ilgili olabilecek genital ülser saptandı. Ayrıca bilateral labia minoralarda totale yakın adezyon saptandı. Olgu 2’nin tedavisinde genel anestezi altında manuel ayırma tekniği uygulandı. İşlem sonrasında topikal steroidli krem verildi. Labial adezyonlar özellikle premenarş döneminde, çok seyrek olarak da reprodüktif dönemde lokal enflamasyon ve düşük östrojen düzeyine bağlı olarak görülebilir. Anestezi altında keskin veya künt diseksiyon, anestezi altında veya anestezisiz manuel ayırma, topikal östrojen, oral östrojen, topikal steroid alternatif tedavi yöntemleridir. Tedavi yöntemlerinin başarı oranı %90’a kadar çıkmaktadır. Rekürrens oranı ise manuel veya keskin diseksiyon yöntemleri ile %4-20 arasında değişmektedir.

Labial Adhesion in Adulthood: A Report of Two Cases

Labial adhesions are generally observed in the premenarchal and postmenopausal period. They are rarely seen in adulthood. Here, two labial fusion cases in the reproductive period are discussed. In the first case, 38-year-old virgin woman presented with anuria to the emergency unit. On her physical examination, labia were fused totally including periurethral area. His history revealed that she was mentally retarded and had primary amenorrhea. She had poor selfcare. On her genital examination, she had secondary sexual characteristics, including axially- pubic hair and breast development at Tanner stage-5. In her surgical treatment, the labia were overturned and a well-defined introitus was constituted. After the operation, topical estrogen prescribed. In second case, a forty-two year old woman with Behçet’s disease presented with dysuria and difficulty in voiding for about one month. Her obstetric examination revealed that she had two vaginal births. On pelvic examination, genital ulcer was determined on the labium. Besides, adhesion almost completely fused into the bilateral labia minora. For surgical treatment, manual separation technique was used under general anesthesia. After the operation, topical steroid was prescribed. Labial adhesions are observed, especially in the premenarchal period. However, they may be very rarely seen in the reproductive period due to local inflammation and circulating low estrogen levels. Topical estrogens, topical steroids, oral estrogen treatment, manual separation under anesthesia or without anesthesia, sharp or blunt dissection under anesthesia are alternative treatment methods. The success rates of these treatment methods exceed 90%. Besides, the recurrence rate varies between 4% and 20% with manual and sharp dissection methods.

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1. Acker A, Jamieson MA. Use of Intranasal Midazolam for Manual Separation of Labial Adhesions in the Office. J Pediatr Adolesc Gynecol 2013; 26: 196-8.
2. Soyer T. Topical estrogen therapy in labial adhesions in children: therapeutic or prophylactic. J Pediatr Adolesc Gynecol 2007; 20: 241-4.
3. Leung AK, Robson WL, Tay-Uyboco J. The incidence of labial fusion in children. J Paediatr Child Health 1993; 29: 235-6.
4. Girton S, Kennedy C. Labial adhesion: a review of etiology and management. Postgraduate Obstetrics & Gynecol 2006; 26: 1-5.
5. Eroğlu E, Yip M, Oktar T, Kayiran SM, Mocan H. How Should We Treat Prepubertal Labial Adhesions? Retrospective Comparison of Topical Treatments: Estrogen Only, Betamethasone Only, and Combination Estrogen and Betamethasone. J Pediatr Adolesc Gynecol 2011; 24: 389-91.
6. Bradford J, Fischer G. Surgical Division of Labial Adhesions in Vulvar Lichen Sclerosus and Lichen Planus. J Low Genit Tract Dis 2013; 17: 48-50.
7. Watanabe T, Matsubara S, Fujinaga Y, Asada K, Ohmaru T, Suzuki M. Manual separation followed by local cleanliness for pediatric labial adhesion jog. J Obstet Gynaecol Res 2010; 36: 667-70.
8. Kucuk M, Halil S, Ocer F, Oral F. Labial fusion first diagnosed during pregnancy with voiding difficulty and its management. Clin Exp Obstet Gynecol 2011; 1: 94-5.
9. Caglayan EK. A rare complication of vaginal delivery: labial adhesion. Clin Exp Obstet Gynecol 2014; 41: 98-9.
10. Awang NA, Viegas C, Viegas OA. Incomplete bladder emp-tying due to labial fusion in a pubertal girl: a delayed consequence of female circumcision. Aust N Z J Obstet Gynaecol 2004; 44: 372-3.
11. Tebruegge M, Misra I, Nerminathan V. Is the topical application of oestrogen cream an effective intervention in girls suffering from labial adhesions? Arch Dis Child 2007; 92: 268-71.
12. Lazarou G, Maldonado MQ, Mitchell K. Complete Labial Fusion with Vaginal Constriction Band Presenting as Incomplete Voiding. Female Pelvic Med Reconstr Surg 2013; 19: 181-3.
13. Tsianos GI, Papatheodorou SI, Michos GM, Koliopoulos G, Stefos T. Pyosalpinx as a sequela of labial fusion in a post-menopausal woman: a case report. J Med Case Rep 2011; 5: 546.
14. Smith C, Smith PD. Office pediatric urologic procedures from a parental perspective. Urology 2000; 55: 272-6.
15. Goldman RD. Estrogen cream for labial adhesion in girls. Can Fam Physician 2013; 59: 37-8.
16. Mayoglou L, Dulabon L, Martin-Alguacil N, Pfaff D, Schober J. Success of Treatment Modalities for Labial Fusion: A Retrospective Evaluation of Topical and Surgical Treatments. J Pediatr Adolesc Gynecol 2009; 22: 247-50.
17. Rouzier R, Haddad B, Deyrolle C, Pelisse M, Moyal-Barracco M, Paniel B. Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol 2002; 186: 49-52.
18. Goldstein AT, Burrows LJ. Surgical treatment of clitoral phimosis caused by lichen sclerosus. Am J Obstet Gynecol 2007; 196: 126. e1-4.
19. Tebruegge M, Misra I, Nerminathan V. Is the topical application of oestrogen cream an effective intervention in girls suffering from labial adhesions? Arch Dis Child 2007; 92: 268-71