Synechiae in girls

Many parents may not be aware of the common condition known as synechiae in girls. It describes the partial or total adhesion of the labia in young girls. While it can occasionally raise concerns, it is usually not a serious condition.

This can naturally cause concern as parents notice it during routine hygiene care or check-ups. Nonetheless, synechiae typically go away on their own or with easy care.

Parental confidence in handling the situation and knowing when to consult a healthcare professional can be increased by parents having a better understanding of the causes, symptoms, and available treatments.

What is it

Girls experiencing synechiae is a fairly common occurrence. Medical statistics, which suggest that 3-4% of babies experience labia fusion, appear promising only when read on paper. In fact, at least 25–30% of infants and older babies in the practice of a specific pediatrician show some degree of clinical symptoms associated with this disease. Simply put, some doctors "write off" them due to the girl’s age-related physical characteristics and don’t think they are serious enough to be documented in the medical file.

The union of the labia is called a synechiae. Labia majora can develop collectively. However, the labia minora are more frequently fused together, usually in the lower third. They don’t usually grow together the whole way. Furthermore, the labia majora and labia minora hardly ever grow together.

The majority of the time, the illness has no negative effects on the child. However, pathological fusion can result in concurrent inflammatory disorders that cause both the vaginal entrance and the urethral outlet to close, causing the girl to experience a variety of unpleasant sensations.

Intimate problems like these are common in girls between the ages of six months and seven or eight years.

At this age, puberty typically starts, and the issue goes away on its own. The majority of these diagnoses occur between the ages of one and three years, when paperwork for kindergarten is being completed and parents bring their daughter in for a significant medical examination. It is required to see a pediatric gynecologist.

The Greek word "synechia" means "continuity, connection" when translated. Although the illness has long been known to humanity, detailed descriptions of it were not published until the 20th century. Even now, medical professionals and scientists disagree sharply over whether synechia is a disease in and of itself or if there is sufficient evidence to classify it as a physiological condition. a very contentious topic. After all, synechia is as natural for the majority of female children under the age of seven as physiological phimosis is for the boys.

Causes of occurrence

The precise causes of the labia’s fusion are unknown. However, recent research and experiments suggest that there is most likely a link between the synthesis of sex hormones and the development of synechia. A newborn girl borrows too much estrogen (the female sex hormone) from her mother and has almost no sex hormones of her own. Because it gives the labia flexibility, adhesions typically do not form in newborns or infant girls until six months of age.

The mother’s estrogen stops after six months, and the baby has insufficient amounts of its own. The labia become less elastic and are more prone to combining when adverse circumstances arise. Among these are:

• allergic reactions – their skin manifestations that affect the genital area. In this case, an inflammatory process occurs in the damaged skin, and when healing, the labia merge;

• inflammatory processes of bacterial origin – the mechanism of occurrence is the same. Bacteria that cause inflammation of the genitourinary tract can get on the genitals as a result of hygiene errors, for example, improper washing of the child;
• mechanical irritation of the genitals – if the child wears underwear and clothes made of synthetic fabric, then the likelihood of developing irritation, and then healing with fusion is quite high;
• chemical irritation – if the child"s clothes are washed with aggressive detergents not intended for children, if the girl"s diaper is not changed often enough or if she is washed with soap several times a day;
• non-obvious reasons – a situation when there are adhesions, but the above factors were absent.

Establishing the diagnosis of "adhesions" does not heavily depend on determining the cause as such. The precise cause of the adhesion has no bearing on the medical strategy or course of treatment.

It is assumed by default that every young girl has an adherence predisposition, and all of the aforementioned factors are evaluated as thorough causes.

Symptoms and signs

Adhesion can take weeks or months to develop, but it can also happen in a few short days. Usually, the child has no emotional reaction to this process. The girl acts the same and shows no signs of pain, itchiness, or discomfort. That is the reason it is typically impossible to find Sinechia in the beginning. Once the fusion has taken place, intimate "violation" becomes evident.

The exception is when the urethra is entirely or partially overlapped by the labia as they fuse in their upper third. In this instance, the child experiences discomfort with each urination, but since there isn’t much severe or noticeable pain, it’s possible that the child isn’t expressing his discomfort to others very well. When watchful parents notice their daughter pushing during a urinal session, they may blush, get concerned, and shoe the girl. However, because these symptoms won’t be obvious or distinct, they might also go unrecognized.

When a thick film develops in between the labia, the sinechia are visible. The so-called median strip, or the very fusion zone, is visible in the center of this partition. The vaginal opening closes by a few millimeters, a third, half, or fully when the labia minora fuse. Usually, if the labia majora and labia minora fuse, both sides will exhibit symmetry. The urethral entrance cannot be seen if the adhesions are fully formed.

Inflammation such as vulvitis or vulvovaginitis, as well as redness of the external genitalia, may accompany complicated adhesions. There may be vaginal discharge that smells strongly of sulfur or purulent. The child’s behavior changes, they experience excruciating pain and itching, and their anxiety levels rise—especially after every urination. Only in the case of complex adhesions may the child’s temperature rise slightly. She is functioning normally in all other circumstances, the child’s health is good, and synechia has no effect on her appetite, sleep patterns, or level of activity.

Diagnostics

Parents are free to check adhesions on their own if they so choose. This doesn’t require any specialized equipment because it is easy to see the film connecting the labia.

A specialist physician’s office should be the first place to go when looking for adhesions in the genital area at home.

A specialist that is available in nearly every children’s clinic these days is a pediatric gynecologist.

In order to determine whether the issue is more physiological in nature or if complex adhesions are involved, the doctor will examine the child’s external genitalia, evaluate the degree of adhesion, and order a number of additional tests. The following tests must be completed by you:

• culture for urogenital infections;
• culture to determine the presence of bacteria and their sensitivity to certain antibiotics;
• general blood and urine tests;
• ultrasound examination of the pelvic organs (rarely prescribed, only if the adhesion is extensive and there are visual signs of inflammation).

It’s highly likely that the doctor won’t order more tests if a visual examination reveals tiny adhesions without any indications of inflammation.

Girls who have synechiae, a condition where the labia stick together, may experience discomfort, but it’s usually not serious and usually goes away on its own or with minimal care. Parents should seek advice from a pediatrician and be aware of the symptoms, which include difficulty urinating or irritation. Concerns can be allayed and complications can be avoided with early comprehension and tender care.

Danger

Generally speaking, synechiae do not endanger the girl’s life or health. But when the urethra completely fuses or overlaps with adhesions, a closed space is formed beneath the film that gathers urine remnants and vaginal discharge. A closed space is a perfect place for different opportunistic and pathogenic bacteria to multiply. Ignoring this will cause the inflammation to "rise" higher and affect the child’s ovaries, appendages, and uterus—all important reproductive organs.

Complete and complex synechiae are therefore typically treated. Not every synechiae can be described in the same way. It might be left alone if the film does not cover the urethra or vagina and there is no inflammation. Since most doctors are well aware that 90% of adhesions resolve on their own by the time a child reaches puberty, around the age of 7-8, systematic observation is the only treatment recommended for the child. The external genitalia will become denser and more elastic, and the fusion will spontaneously disappear, as soon as the level of sex hormones is sufficient.

The most common type of adhesions, simple adhesions, do not alter or deform the girl’s labia or impair her ability to reproduce in the future.

Treatment

Treatment is not necessary for adhesions that do not cause inflammation, itching, or burning, nor do they obstruct the vaginal or urethral entrances. It is sufficient to maintain control over the situation by seeing a pediatric gynecologist biannually, who will evaluate the level of dynamics and fusion. Treatment is necessary for babies who have an unpleasant adhesion process in the labia area at a younger age, which causes inflammation and prevents the release of urine and vaginal secretions, as well as for girls who have not begun to resolve the issue after eight years.

Conservative measures

Gentle conservative treatment is always the first line of treatment for synechia. This diagnosis does not warrant immediate surgery. The girl can receive excellent care at home for her synechia; hospitalization is not necessary.

An ointment containing estrogen is prescribed to make up for the lack of female sex hormone. Ovestin cream is typically applied. Usually, the treatment lasts for five to six weeks. This is how the plan appears:

• The first 14 days, external treatment of the labia with Ovestin is carried out twice a day – in the morning and in the evening.
• The second 14 days, external treatment with this drug is carried out only once a day, for example, in the morning. In the evening, regular baby cream or Vaseline oil is used for lubrication. Sea buckthorn or peach oil can also be used.
• During the following week, only oil or baby cream is used.

It is crucial to use Ovestin as directed. Use just your finger to do this; do not use cotton swabs or tampons. Applying the cream solely to the fusion site and lightly pressing with your finger will prevent it from getting on the tissues next to the adhesion. The separation process is greatly impacted by this pressing effect.

Following such a course, the outcome is evaluated. If everything works out well, "Ovestin" causes the adhesions to separate. In the event of a negative result, there is no separation. When the result is uncertain, there is only a partial separation.

Following the completion of the separation, "Kontraktubeks" is advised. The gel or ointment known as "Kontraktubeks" inhibits re-adhesion and encourages the development of elastic, smooth tissue. They apply a thick layer of gel or ointment to lubricate the labia twice a day, in the morning and the evening.

Reviews from irate parents complaining that "Kontraktubeks" did not assist their child with adhesions are common. According to experts, this is only conceivable if the medication was administered improperly, which could have happened early in the course of treatment, for instance, before the labia separated completely or with partial separation. Complete initial adhesion separation is a requirement for a successful course of treatment with this kind of gel.

The first and last phases of the treatment will differ slightly if there is an inflammatory process.

You will need to treat the external inflammation for a few days prior to using Ovestin to separate the lips. It is advised to wash for this using a calendula and chamomile infusion without using soap. There should be three to four times a day that the procedures are performed.

Following each, Bepanten ointment is applied to the inflammatory site. You can start the above-described course as soon as the redness goes away.

Ovestin therapy is occasionally augmented with fusion zone treatments using an oil solution containing methyluracil ointment and vitamin A. Typically, a five-day course adds one of these procedures per day. It is normal for parents to notice a small amount of swelling in the daughter’s labia at the start of the conservative treatment course. This is a typical procedure; don’t postpone the treatment. Slight swelling is typically a side effect that resolves after three to four procedures.

Surgical intervention

If conservative treatment did not help or helped with a questionable result (it was not possible to completely eliminate adhesions with medicinal ointments), an operation is performed to remove the film from the child"s labia. Here it is imperative to warn the parents – the number of "sadistic" gynecologists in Russia is off the charts. According to the old, Soviet practice, when they did not stand on ceremony with synechiae, the doctor may suggest separating the labia manually, with a finger, essentially simply breaking through the connective tissue. Indeed, just a few decades ago this is exactly what they did. But now it is the 21st century, and therefore mothers and fathers should not subject their daughter to a painful procedure.

The only thing you should consent to is a polite separation. It is done with instruments rather than a finger while under local anesthesia. Everything proceeds painlessly and swiftly. In order to prevent relapse, "Ovestin" is prescribed in a course for 7–10 days following the procedure, followed by "Kontraktubeks."

The likelihood of re-fusion is still very high even in the case of everything being done perfectly. Available data indicates that it is between 25 and 30 percent.

The likelihood of the issue reoccurring drops to 5% if the parents and physician treated the problem seriously and underwent postoperative therapy.

Topic	Explanation
What is synechiae?	Synechiae in girls is the partial or complete sticking together of the labia, typically occurring in young children.
Causes	Synechiae may occur due to irritation, lack of estrogen, or poor hygiene.
Symptoms	Common signs include difficulty urinating, discomfort, or noticing that the labia appear fused.
Treatment	Treatment can involve the use of estrogen cream, gentle care, or, in rare cases, a doctor may need to separate the labia.
Prevention	Good hygiene, moisturizing creams, and avoiding irritants can help prevent synechiae from forming.

Comprehending synechiae in females is crucial for early detection and management of this prevalent ailment. Despite its alarming appearance, it is frequently treatable with the right care.

Gentle hygiene habits and routine examinations can aid in the prevention and treatment of synechiae. Medical attention might be required in certain situations, but it’s comforting to know that many cases end with no lasting problems.

Parents can minimize discomfort or complications from synechiae and ensure their daughters remain healthy by being informed and collaborating closely with healthcare providers.

Video on the topic

Synechiae. – Advice from a pediatric gynecologist.

Synechiae of the labia minora

Synechiae in girls. Causes and treatment.

Synechiae in girls.

Synechiae in girls

Synechiae in girls: causes, symptoms, treatment, prevention

How to treat fusion of the labia (synechiae)? – Doctor Komarovsky

When to treat synechiae (fusion of the labia)? – Doctor Komarovsky