The Case Files: A Rare Case of Labial Fusion

By Prahl, Robert DO; Gebhard, Michelle DO; McGerald, Genevieve DO, and Klein, Richard MD   An 85-year-old woman presented to the emergency department complaining of lower abdominal pain and the inability to urinate for two days. The patient was previously seen in the emergency department for urinary difficulties and diagnosed with labial adhesions and urinary tract infection; she was discharged with a prescription for ciprofloxacin. Her review of systems was otherwise negative on this visit. She was taking oxybutynin for urinary incontinence but denied use of any other medications. The patient had suprapubic tenderness with a palpable distended urinary bladder. Genitourinary exam revealed loss of labial folds and a smooth, flat surface overlying the vaginal introitus consistent with labial adhesion. Management included blunt puncture of the overlying membrane performed with a cotton-tipped applicator. The urine was drained by Foley catheter placed through the puncture site. The patient was started on estrogen cream, and discharged home to follow up with her gynecologist. Labial adhesions, or labial agglutination, result from atrophic, irritated epithelium of the labia minora that subsequently adhere together. This condition is related to decreased tissue estrogen and local inflammation. The incidence of labial adhesions in prepubescent girls is 1.8 percent, but it is a rare finding with no previously estimated incidence in postmenopausal women. Postmenopausal women have decr...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research