TITLE:
Severe Labial Agglutination Release in a Postmenopausal Woman
AUTHORS:
Rebecca James, Anne Sammarco, David Sheyn, Sangeeta Mahajan
KEYWORDS:
Labial Agglutination, Hypoestrogenic State
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.14,
September
29,
2014
ABSTRACT: Labial
agglutination occurs when the labia minora have become fused in the midline
through either filmy or dense adhesions, forming a raphe. This condition is
typically seen in pre-pubertal girls; however, there have been cases reported
in the literature of labial agglutination in postmenopausal and reproductive
aged women. Labial agglutination has been associated with local irritation and
inflammation in the setting of a hypoestrogenic state. Topical treatment is
usually recommended prior to manual separation. However, some postmenopausal
women have been refractory to conservative management, and surgery may then be
required. We present a case of a 79-year-old Caucasian gravida 3 para 3 who was
referred for treatment refractory labial agglutination for 3 years. The
patient’s complaints included a small trickle escaping from the introitus
during urination and the sensation of little urinary control. The patient
underwent an exam under anesthesia. Gentle blunt dissection with a lacrimal
dilator easily separated the labia minora down the visible midline fusion line
(raphe). Bimanual exam then revealed a 12-week-sized enlarged uterus confirmed
on ultrasound to be an 8 × 8 × 7 cm irregular mass concerning for uterine
cancer. Proceeding to an operative release of severe labial agglutination can
relieve patient discomfort and frustration when estradiol therapy has failed.
In addition to alleviating symptoms, releasing labial agglutination can also
provide the gynecologist access to critical screening procedures such as
cervical cytology or a bimanual exam, all of which could lead to a diagnosis or
pre-cancerous or cancerous lesions.