Labial fusion: Common but often ignored
A one year and seven months old girl always cried whenever she passed out urine. Her mother, Topister Imayitum, who resides in Achanga IDP Camp, says she did not realise that the vulva of her baby was too small until she was two weeks old. “Whenever my daughter would want to urinate, she would cry
By Halima Shaban
A one year and seven months old girl always cried whenever she passed out urine. Her mother, Topister Imayitum, who resides in Achanga IDP Camp, says she did not realise that the vulva of her baby was too small until she was two weeks old. “Whenever my daughter would want to urinate, she would cry and the urine would pass out in drops,†she said. She tried to spread her vulva wide to ease the baby’s urinating but Imayitum felt like she was hurting her more.
“I first went to Magoro health centre III where a nurse referred me to Katakwi health centre. I was still failing to go there when I heard of these people,†Imayitum says.
She was referring to the Action Aid International mobile clinic which arrived in Katakwi to treat sexual and reproductive health problems. Dr Haruna Mwanjje, a Gynaecologist at Mulago Hospital, who examined the baby during the three-day mobile clinic, called it congenital labial fusion. “It is a vulva abnormality that needs a simple flap procedure to separate the fused labia. Surgery is rarely usedâ€.
Dr Alia Godfrey, a member of the Association of Obstetricians and Gynaecologist at Mulago, says labial fusion is when the female’s labia get attached and adhered to each other in the middle line, leaving a small opening or some times closing off the vagina. It is a rare event, especially in adults where it is an acquired lesion.
He says in adults, it is mainly caused by poor hygiene, oestrogen deficiency, lack of sexual activity, repeat urinary infections and inflammation that occurs secondary to various resultant scarring. Inflammation may cause the labia skin to peel off and during healing, the labia get fused together. But this usually happens after sexual abuse in the child.
Very few adults require surgical correction and re-fusion. Local oestrogen works even in patients who require surgery to prevent re-fusion and allay the patient’s anxiety and emotional trauma.
In babies, it is congenital meaning that the baby is born with the condition. Alia says in girls, six months to six years, it can be managed by a simple procedure of separating the fused labia or application of an oestrogen cream.
Labial fusion is never seen in the reproductive ages but is more common in postmenopausal women.
In Uganda, cases of labial fusion are common but some times parents take time to discover that a child has an abnormality. Research done by Association of Obstetricians and Gynaecologists of Mulago Hospital says about 200 children in Uganda are diagnosed with congenital labia fusion every year and most of these come from the Central and Eastern regions.
Doctors also note that it occurs in postmenopausal women but in some of these cases, most of these conditions are just ignored.
Mwanjje says that developmental abnormalities of the vulva and vagina are often easy to correct, but also easy to misdiagnose. “You need to be familiar with the syndromes before you treat. Many people are confronted with these conditions and they don’t know what they really are. With the obstructions, for example, they may just think it is an imperforate hymen and are not even aware that there is an entity called obstructed hemivagina,†he said.
When identified early, congenital labial fusion can be easily treated. But Mwanjje advises that a vaginal examination may help the parent understand the daughter’s problem. But it is not wise to treat it yourself. “For this baby, we separated the fused labias using a blunt instrument in a simple office procedure,†he said.
If left untreated for long, it leads to repeated urinary tract infections, bladder distension and kidney problems due to urinary outflow obstruction
Treatment may include simple reconstruction of the labia without any operation or, when the condition is caused by lack of oestrogen, an oestrogen cream can be prescribed. The cream is applied on the fussed labia until when they separate.
Sometimes, the condition can also disappear without treatment when the girl gets her first periods.
A one year and seven months old girl always cried whenever she passed out urine. Her mother, Topister Imayitum, who resides in Achanga IDP Camp, says she did not realise that the vulva of her baby was too small until she was two weeks old. “Whenever my daughter would want to urinate, she would cry and the urine would pass out in drops,†she said. She tried to spread her vulva wide to ease the baby’s urinating but Imayitum felt like she was hurting her more.
“I first went to Magoro health centre III where a nurse referred me to Katakwi health centre. I was still failing to go there when I heard of these people,†Imayitum says.
She was referring to the Action Aid International mobile clinic which arrived in Katakwi to treat sexual and reproductive health problems. Dr Haruna Mwanjje, a Gynaecologist at Mulago Hospital, who examined the baby during the three-day mobile clinic, called it congenital labial fusion. “It is a vulva abnormality that needs a simple flap procedure to separate the fused labia. Surgery is rarely usedâ€.
Dr Alia Godfrey, a member of the Association of Obstetricians and Gynaecologist at Mulago, says labial fusion is when the female’s labia get attached and adhered to each other in the middle line, leaving a small opening or some times closing off the vagina. It is a rare event, especially in adults where it is an acquired lesion.
He says in adults, it is mainly caused by poor hygiene, oestrogen deficiency, lack of sexual activity, repeat urinary infections and inflammation that occurs secondary to various resultant scarring. Inflammation may cause the labia skin to peel off and during healing, the labia get fused together. But this usually happens after sexual abuse in the child.
Very few adults require surgical correction and re-fusion. Local oestrogen works even in patients who require surgery to prevent re-fusion and allay the patient’s anxiety and emotional trauma.
In babies, it is congenital meaning that the baby is born with the condition. Alia says in girls, six months to six years, it can be managed by a simple procedure of separating the fused labia or application of an oestrogen cream.
Labial fusion is never seen in the reproductive ages but is more common in postmenopausal women.
In Uganda, cases of labial fusion are common but some times parents take time to discover that a child has an abnormality. Research done by Association of Obstetricians and Gynaecologists of Mulago Hospital says about 200 children in Uganda are diagnosed with congenital labia fusion every year and most of these come from the Central and Eastern regions.
Doctors also note that it occurs in postmenopausal women but in some of these cases, most of these conditions are just ignored.
Mwanjje says that developmental abnormalities of the vulva and vagina are often easy to correct, but also easy to misdiagnose. “You need to be familiar with the syndromes before you treat. Many people are confronted with these conditions and they don’t know what they really are. With the obstructions, for example, they may just think it is an imperforate hymen and are not even aware that there is an entity called obstructed hemivagina,†he said.
When identified early, congenital labial fusion can be easily treated. But Mwanjje advises that a vaginal examination may help the parent understand the daughter’s problem. But it is not wise to treat it yourself. “For this baby, we separated the fused labias using a blunt instrument in a simple office procedure,†he said.
If left untreated for long, it leads to repeated urinary tract infections, bladder distension and kidney problems due to urinary outflow obstruction
Treatment may include simple reconstruction of the labia without any operation or, when the condition is caused by lack of oestrogen, an oestrogen cream can be prescribed. The cream is applied on the fussed labia until when they separate.
Sometimes, the condition can also disappear without treatment when the girl gets her first periods.