From the Guidelines
Vaginal adhesions should be treated with topical estrogen cream, such as conjugated estrogens cream (Premarin) or estradiol cream (Estrace), applied to the affected area once or twice daily for 2-4 weeks to help soften and separate the adhesions. This treatment approach is based on the principle of addressing the underlying cause of vaginal adhesions, which is often related to low estrogen levels, particularly in postmenopausal women 1.
Treatment Options
- Topical estrogen cream is the primary treatment for vaginal adhesions, with the goal of softening and separating the adhesions 1.
- For mild adhesions, hormonal therapy alone may be sufficient, while more severe cases might require manual separation by a healthcare provider, often performed under local anesthesia 1.
- Following separation, continued estrogen cream use is recommended to prevent recurrence, along with regular gentle dilation to maintain vaginal patency 1.
Important Considerations
- Vaginal adhesions can cause discomfort, abnormal discharge, urinary problems, or pain with intercourse, and may be asymptomatic in some cases 1.
- Treatment should be individualized, taking into account the severity of the adhesions, the patient's overall health, and any underlying medical conditions 1.
- In children, treatment should be supervised by a pediatric gynecologist, using smaller doses of estrogen 1.
Additional Therapies
- Pelvic physical therapy, integrative therapies such as yoga and meditation, and cognitive behavioral therapy (CBT) may also be helpful in improving sexual function and reducing symptoms associated with vaginal adhesions 1.
- Vaginal moisturizers and gels, oils, and topical vitamin D or E can help alleviate symptoms such as vaginal dryness and sexual pain 1.
From the Research
Definition and Causes of Vaginal Adhesion
- Vaginal adhesion, also known as labial adhesion or labial fusion, is a condition where the labia minora are partially or completely fused together 2.
- This condition can be congenital or acquired, with acquired cases often occurring in estrogen deficiency states, such as in prepubertal girls and postmenopausal women 2.
- Aggravating factors include chronic inflammation, poor hygiene, eczema, lichen planus, and local trauma 2.
Symptoms and Presentation
- Patients with vaginal adhesion may be asymptomatic or present with urinary or vulval symptoms 2.
- The condition can affect women of all ages, with a mean age of 13.2 months in prepubertal girls 3 and 76 years in postmenopausal women 2.
Treatment Options
- Topical estrogen therapy is a common treatment for vaginal adhesion, with a success rate of 79% in prepubertal girls 4.
- Topical estrogen cream can be applied to the fused area twice a day until the adhesions are totally lysed 3.
- Other treatment options include topical betamethasone cream, combination estrogen and betamethasone creams, and surgical separation 5.
- Surgical separation is recommended if conservative treatment fails 5.
Side Effects and Recurrence
- Side effects of topical estrogen therapy include vulval pigmentation, breast enlargement, and minimal breast development [(3,4)].
- Recurrence of labial fusion can occur, with a rate of 41% in prepubertal girls 4 and 10% in postmenopausal women 2.
- Estrogen therapy initiated after surgical failure may be unsuccessful 4.