Persistent Labial Minora Fusion in Reproductive Age Women: A Retrospective Case Series of Nine Patients and Review of Literature

Figures & data

Table 1. Summary of reported cases of labial minora fusion in the reproductive age

Author	Age of diagnose (years old)	Age of treatment (years old)	Course of disease (years)	Chief complaints	Other defects	prognosis
Goldstein et al.^Citation1	20	20	0	Difficult coitus	Normal	Not mentioned
Topcuoglu et al.^Citation2	18	18	0	Urinary retention	Normal	Not mentioned
Watanabe et al.^Citation3	35	35	0	Voiding difficult	Normal	Fully recovered
Kuo et al.^Citation4	30	30	0	Difficult coitus	Not mentioned	Fully recovered
Kutlu et al.^Citation5	22	22	0	Urinary retention	Not mentioned	Not mentioned
Ozekinci et al.^Citation6	22	22	0	Difficult coitus	Normal	Fully recovered
Guldberg et al.^Citation7	15	15	0	Voiding difficult	Normal	Fully recovered
Evruke et al.^Citation8	8	18	10	Recurring urinary tract infections	Normal	Fully recovered
Erdoğdu et al.^Citation9	33	33	0	Voiding difficult	Normal	Not mentioned
Kucuk et al^Citation10	24	24	0	Urinary symptoms and early pregnancy	Normal	Fully recovered
Pushpawati et al.^Citation11	15	16	1	Urinary symptoms	Normal	Fully recovered
Tsujita et al.^Citation12	21	21	0	Urinary symptoms	Normal	Fully recovered
Kumar et al.^Citation13	17	17	0	Urinary symptoms	Not mentioned	Fully recovered
	19	20	1	Vulva defects	Normal	Fully recovered
	22	23	1	Urinary symptoms	Not mentioned	Fully recovered
Halder et al.^Citation14	28	28	0	Vulva defects	Normal	Fully recovered
Özalp et al.^Citation15	Not mentioned	31	Not mentioned	Urinary symptoms and difficult coitus	Normal	Fully recovered

Table 2. Course of disease and clinical symptoms of 9 patients treated in our hospital

NO.	Age of diagnose (years old)	Age of treatment (years old)	Course of disease (years)	Chief complaint	Other defects	Menses (menarche age, period)	Sexual activity
1	32	33	1	Inability to have sex intercourse	Normal	13, 5/30	Inability to have sexual intercourse
2	10 months	14	13	Vulva defect	Normal	11, 2–6/27–28	None
3	3	30	27	Vulva defect	Normal	14, 2–3/30–60	None
4	28	28	1 month	Labial fusion during premarital screening	Normal	12, 5/30	None
5	1	23	22	Vulva defect	A double cervical and complete uterine septum, Stress urinary incontinence	16, 3–5/30	None
6	22	24	2	Labial fusion during regular physical examination	Normal	15, 3–5/30–40	None
7	15	20	5	Blood urine, urinary symptoms	Normal	13, 7/15–60	None
8	22	22	5 months	Labial fusion	Normal	12, 7–9/30	None
9	0	13	13	Vulva defect	Normal	10, 1–20/60–90	None

Figure 1. Procedure for labial fusion dissection. (a, b) Overview of the fused labial minora. Only the urethra meatus was visible. (c) A metal urethral catheter was inserted as a guide to avoid urethral injuries. (d) The fused labial minora were separated, and the vagina was revealed to have a normal width. (e) A normal cervix was evident. (f) The edges of the incision were sutured with 1/0 coated VICRYL separately

Goldstein AI, Rajcher WJ. Conglutination of the labia minora in the presence of normal endogenous estrogen levels: an exception to the rule. Am J Obstet Gynecol. 1972;113(6):845–46. doi:10.1016/0002-9378(72)90572-8.

 PubMed Web of Science ®Google Scholar

Topcuoglu MA, Koc O, Duran B, Donmez M. Labial fusion causing acute urinary retention in a young adult: a case report. Aust N Z J Obstet Gynaecol. 2009;49(1):115–17. doi:10.1111/j.1479-828X.2008.00946.x.

 PubMed Web of Science ®Google Scholar

Watanabe T, Matsubara S, Ikeda T, Kawai S, Nakamura S, Nakai H. Labial adhesion causing voiding but not sexual problems in a married woman. J Obstet Gynaecol Res. 2013;39(1):415–19. doi:10.1111/j.1447-0756.2012.01934.x.

 PubMed Web of Science ®Google Scholar

Kuo DM, Chuang CK, Hsieh CC, Liou JD, Chen KC, Hsieh TT. Labial fusion in a thirty-year-old woman. Acta Obstet Gynecol Scand. 1998; 77(6): 697–98. http://europepmc.org/abstract/MED/9688253

 PubMed Web of Science ®Google Scholar

Kutlu O, Koksal IT. Labial adhesion in a reproductive aged girl. Saudi Med J. 2010;31:202–03.

 PubMed Web of Science ®Google Scholar

Ozekinci M, Yucel S, Sanhal C, Akar ME. Labial fusion causing coital and voiding difficulty in a young woman. Adv Sex Med. 2013;03(1):11–13. doi:10.4236/asm.2013.31002.

 Google Scholar

Guldberg R, Thybo S, Andersen B. Synechia vulvae – an unusual cause of urinary symptoms in a 15-year-old girl. Acta Obstet Gynecol Scand. 2007;86(2):251–52. doi:10.1080/00016340600608287.

 PubMed Web of Science ®Google Scholar

Evruke C, Ozgunen FT, Kadayifci O, Atay Y, Demir C, Aridogan N. Labial fusion in a pubertal girl: a case report. J Pediatr Adolesc Gynecol. 1997;9(2):81–82. doi:10.1016/S1083-3188(96)70016-5.

 Google Scholar

Erdoğdu E, Demirel C, Tahaoğlu AE, Özdemir A. Labial fusion: a rare cause of urinary retention in reproductive age woman and review of literature. Turk Urol Derg. 2017;43(1):98–101. doi:10.5152/tud.2017.58897.

 PubMed Web of Science ®Google Scholar

Kucuk M, Halil S, Ocer F, Oral E. Labial fusion first diagnosed during pregnancy with voiding difficulty and its management: a case report. Clin Exp Obstet Gynecol. 2011;38(1):94-5.

 Web of Science ®Google Scholar

Singh V, Sinha S, Singh A. Labial agglutination in a pubertal girl. J Clin Diagn Res. 2018;12(1):QD01–QD02. doi:10.7860/JCDR/2018/31835.11087.

 Google Scholar

Tsujita Y Asakuma J, Kanbara T, Yoshii T, Azuma R, Sumitomo M, Asano. A case of labial adhesion in a reproductive woman. Acta Urol Jpn. 2010;56(8):463-5.

 Google Scholar

Kumar RK, Sonika A, Charu C, Sunesh K, Neena M. Labial adhesions in pubertal girls. Arch Gynecol Obstet. 2006;273(4):243–45. doi:10.1007/s00404-005-0060-8.

 PubMedGoogle Scholar

Halder A, Pati S, De Pati A, Halder S. Complete vulvar fusion in an adult woman mimicking vaginal agenesis. J Obstet Gynaecol (Lahore). 2009;29(4):361–62. doi:10.1080/01443610902842607.

 Web of Science ®Google Scholar

Özalp B, Bilgin Karabulut A. Labial fusion in an adult woman represented as a congenital disorder: case report. Turkiye Klin Jinekoloji Obstet. 2010;20(1):57-59.

 Google Scholar