According to statistics, 10 out of 100 girls aged from birth to two years are diagnosed with synechia of the labia. What it is? This is serious? How to treat? Can it be prevented? All our questions about synechiae in girls were answered by Tatiana ZHORNIK, doctor at the Zdravitsa Medical Center, obstetrician-gynecologist of the highest category, candidate of medical sciences.
Possible contraindications. Specialist consultation required!
What are synechiae?
Synechia is an adhesion that occurs due to the appearance of adhesions between internal organs or external parts of the body. Such fusions of the labia minora, and less commonly, of the labia minora and labia majora, can occur in young girls.
Expert commentary
Fusion of the labia minora may be complete or incomplete. The presence of synechiae in a girl on a small area of skin of the labia minora is not dangerous, does not cause virtually any unpleasant sensations and, subject to hygiene requirements, resolves itself. Synechia or fusion of the labia minora, expressed to one degree or another, is found in approximately 10% of girls aged from birth to 2 years.
Causes of synechiae
Among the natural factors that contribute to the formation of synechiae are the following:
- low content of sex hormones estrogen (in itself is the norm for a child’s body);
- infectious and bacterial diseases;
- allergy.
External factors that can affect the formation of synechiae:
- the occurrence of diaper rash due to untimely change of diapers;
- rubbing underwear in the genital area;
- constant wearing of synthetic underwear;
- excessive hygiene.
Attention! Caring for the delicate skin of little girls requires special delicacy. Too frequent (many times a day) washing, even with the mildest baby soap, can lead to injury to the mucous membrane. Sponges and washcloths are not allowed!
This, of course, does not mean that you should forget about hygiene - insufficient washing can also serve as a provoking factor for the appearance of synechiae.
Expert commentary
First of all, a little anatomy. The labia minora are two thin folds that limit the entrance to the vagina, located from front to back and covered from the outside by the labia majora. The labia minora are not covered with mucous membrane, but with very thin, delicate and vulnerable skin. There is no adipose tissue in the thickness of the labia minora, but there are a lot of sebaceous glands. The peculiarity of the structure (delicate, thin skin) and location (warm, moist environment, closed state) of the labia minora creates the prerequisites for the development of various inflammatory processes, which are often complicated by the development of synechiae (adhesions). Additional factors that increase the risk of synechia formation in girls are considered to be the low level of female sex hormones (estrogens) characteristic of a child’s body and poor hygiene. In some cases, the formation of synechiae in girls is accompanied by metabolic disorders, intestinal diseases (especially often intestinal dysbiosis), allergic processes and helminthic infestations. The formation of synechiae can also be affected by:
- untimely replacement of diapers,
- frequent and generous use of creams containing zinc oxide;
- wearing clothes made of synthetic fibers by a child;
Synechiae usually develop in children under 8 years of age, but are most often identified between birth and 2 years of age.
What should mothers of girls pay attention to?
With timely diagnosis, synechia does not cause discomfort to the baby, is easy to treat and goes away without a trace. However, advanced cases can have serious consequences, so it is important for parents to pay attention to the condition of the genital organs and the general well-being of their daughter and, at the first sign of concern, contact a pediatric gynecologist.
Consultation with a doctor is necessary if:
- the girl constantly experiences difficulty urinating (cries, strains, complains, avoids going to the potty);
- there are even minor changes of any nature in the genital area, including redness, irritation or peeling.
Expert commentary
Firstly, if you notice any changes in the structure of the genital organs in your baby or something is not clear to you, do not be shy and do not think that this is how it should be. Consult a pediatric gynecologist for advice.
Secondly, if the baby has difficulty urinating: she strains, experiences discomfort, is capricious, cries, and this is accompanied by almost every act, it is necessary to sound the alarm. Don’t chalk it up to the fact that your child refuses to sit on the potty because he’s capricious. Perhaps this is a signal.
Thirdly, regularly examine the baby’s genitals - this should be part of a set of hygiene measures. If you experience rashes, redness, peeling or discharge, do not assume that everything will go away on its own. The hope of coping with the problem using home methods most often does not come true. Incorrect or late treatment can lead to complications.
If you have any complaints or questions related to the condition of a girl’s genital organs, immediately contact a gynecologist for children and adolescents for clarification!
Diagnosis of synechiae
If you find any warning signs in your child, do not hesitate - one visit to the doctor will dispel your doubts. To diagnose synechiae or exclude this diagnosis, an examination by a pediatric gynecologist is sufficient. To determine the cause of the disease, the doctor will order tests and, taking into account their results, prescribe comprehensive treatment. But perhaps no treatment is required and the doctor will only recommend regular monitoring and strict hygiene.
Expert commentary
Synechiae in girls is very easy to detect - to make a diagnosis, it is enough to examine the external genitalia. Synechiae in girls looks like a thin whitish-gray film connecting the lips. The film may be on a very small area of the lips, but it can also cover the entire entrance to the urethra and vagina.
To find the causes of the fusion, the pediatric gynecologist often prescribes a series of tests, including:
- smear analysis (to determine the nature of the inflammatory process),
- general blood and urine analysis,
- stool analysis for dysbacteriosis,
- feces for worm eggs and scrapings for enterobiasis,
- blood sugar test.
Possible consequences of the formation of synechiae
Timely treatment will avoid negative consequences. However, it is important to understand: synechias do not tolerate neglect. If the disease is neglected, it can lead to serious complications.
Expert commentary
The danger of this pathology is that when the labia minora and labia majora stick together in the vagina, a closed space is formed in which vaginal discharge accumulates. They, in turn, create a favorable environment for the development of bacteria, which first results in inflammation. Difficulty urinating contributes to the development of inflammation of the bladder (cystitis) or the urethra (urethritis).
Also, synechiae leads to improper formation of the labia, thereby having a direct effect on the reproductive system. In the future, the girl may have problems conceiving and bearing a child. There is also a high risk of developing infertility.
How to treat synechiae?
To treat synechiae, as a rule, a special ointment containing estrogen is prescribed. After completing the course, the duration of which is determined individually, the ointment is gradually replaced with the usual neutral baby cream recommended by the doctor. More serious situations may require surgery. In this case, synechiae are divided under local or general (in rare cases) anesthesia.
Last article updated: 04/09/2018
This article will focus on one of the most common problems in both adult women and girls, as well as boys: synechiae. How to treat synechiae in girls and is there a way to prevent synechiae? Read on for answers to these questions, as well as useful recommendations from experts.
Obstetrician-gynecologist, reproductive specialist
Synechia is an adhesion, fusion of tissues with each other, when connective tissue cords form between them.
In gynecology, synechiae are found: intrauterine, in the fallopian tubes, labia minora and labia majora in girls. Boys have synechiae of the penis.
The presence of intrauterine synechiae in women is called Asherman's syndrome. This pathology is often found in women of reproductive age and is a fairly important problem, as it often leads to infertility and miscarriage.
Causes
The reasons for the development of intrauterine, as well as synechiae in the cervical canal, are most often mechanical damage to the inner layer of the endometrium as a result of curettage.
This procedure is performed in the case of various pathological formations of the uterine cavity (polyps, hyperplasia, uterine fibroids, non-developing pregnancy). Curettage is also possible during surgery (cesarean section), or during metroplasty due to a malformation of the uterus.
In addition, intrauterine synechia develops as a result of inflammatory processes of the endometrium (endometritis). Its occurrence is facilitated by sexually transmitted infections, intrauterine devices, their long-term use, tuberculosis of the genital organs, and multiple abortions.
As mentioned above, intrauterine synechiae, or Asherman's syndrome, is represented by connective tissue cords that fill the uterine cavity throughout or partially. The clinical manifestations of this syndrome will depend on this.
If the synechiae in the uterine cavity are tender, thin, then often clinical manifestations may be absent, and if they are rough and fill the entire uterine cavity, then Asherman's syndrome will manifest itself as menstrual irregularities (painful periods, a decrease or complete absence of menstrual flow, as well as accumulation in the uterine cavity due to the inability to defecate, miscarriage, infertility).
Synechiae in the cervical canal and intrauterine are diagnosed by ultrasound on a certain day of the menstrual cycle and require additional medical intervention, namely hysteroscopy, during which they are dissected.
Severity
Highlight 5 degrees of severity of this adhesive process in the uterine cavity:
- Delicate thin synechiae of the uterine cavity, which are easily destroyed by a medical instrument, free mouths of the fallopian tubes.
- When a single dense adhesion is found in the uterine cavity, but it is easily destroyed by the hysteroscope tube, at this degree the mouths of the fallopian tubes also remain free.
- When multiple dense synechiae and closure of one of the mouths of the fallopian tube are detected in the uterine cavity.
- When a larger area of the uterine cavity is filled with dense, rough synechiae and complete blockage of the orifices of the fallopian tubes.
- Severe fibrosis, the presence of coarse dense adhesions in the uterine cavity, menstrual irregularities, namely a decrease or complete absence of menstruation. In addition, synechiae can be observed in the area of the cervical canal, closing the entrance to it, which requires their dissection.
Asherman's syndrome often causes infertility that a woman experiences when planning a pregnancy. Therefore, it is necessary to timely predict and prevent this pathology of the uterine cavity.
Measures to prevent adhesions in the uterine cavity:
- timely treatment of inflammatory processes of the pelvic organs in any age group;
- competent contraception and its promotion among the younger generation in order to reduce the number of unwanted pregnancies;
- in case of choosing instrumental or medical termination of pregnancy, preference should be given to medical termination;
- carry out endometrial curettage procedures under mandatory ultrasound control;
- limit the use of intrauterine devices for contraception or change them in a timely manner.
Synechiae in children
But synechiae can occur not only in adult women, but also in girls.
Synechiae in infants and in childhood represent adhesion or fusion of the labia minora and/or major, fusion from posterior adhesions - posterior synechiae. In many cases they are called synechiae of the vulva. Translated from Latin, the word “synechia” means “continuity, connection.”
The adhesive process can be observed both along the entire length of the labia, and in a certain area (in the lower third), that is, partial adhesion is noted.
The main question that worries every parent is: what does the treatment of synechia include and whether it is worth separating the synechia.
A delicate, thin, transparent film is formed that partially blocks the entrance to the vagina (with incomplete adhesion) and completely covers the entrance to the vagina and urethra (with complete adhesion of the labia).
In this case, it is necessary to breed synechiae in girls.
They are most often observed in girls aged 6 months to 6 years (usually diagnosed before one year of age)
They arise both within a few days and within several months.
There are 5 main reasons why synechia develops in girls.
The reasons for the development of adhesions in the labia area in girls, as well as in adult women, are: are:
- inflammatory process (vulvitis, vulvovaginitis);
- a consequence of an allergic reaction (with abuse of sweets, citrus fruits);
- violation or, conversely, excessive hygiene of a girl with repeated use of soaps, when, as a result of frequent washing of the girl, injury to the mucous membrane occurs and, as a consequence, inflammation with the subsequent formation of synechiae;
- urinary tract infections;
- tight-fitting underwear made of synthetic fabrics.
Thus, knowing the main reasons for the development of adhesions, it is possible to prevent the development of synechiae in girls.
Such frequent fusion of the labia at such an early age can be explained by the low content of the hormone estrogen, the level of which begins to increase from 7 to 8 years of age.
Symptoms during the formation of fusions of the labia may be absent in the case of incomplete adhesion. In such a situation, a doctor can make a diagnosis during the next examination.
But if a commissure has formed along the entire length of the labia, thereby completely blocking the entrance to the vagina and urethra, then the following signs:
- the child begins to be capricious when urinating;
- straining when urinating;
- cries;
- a stream of urine hitting the lower abdomen;
- in rare cases, an increase in body temperature is observed.
Treatment of synechiae of the labia in children can be conservative (that is, without instrumental interventions) and surgical (using surgical instruments).
Currently, the formation of adhesions in the labia area in children is not considered a pathology (since low estrogen levels in girls up to a certain age are the norm). In this regard, it is believed that synechiae themselves are not a pathology.
Therefore, in case of incomplete fusion, in the absence of clinical manifestations, the synechiae are not separated in girls, but an ointment containing estrogen (Ovestin) and dynamic observation are prescribed.
Ovestin is a drug containing the female sex hormone estriol. It is widely used for synechiae. When the labia stick together, a small amount of ointment is prescribed to be applied to the area of the fusion, that is, to the septum, with a gradual transition to regular ointment containing lanolin to prevent re-sticking.
The drug is sold freely in Russia, without a doctor’s prescription. Its price is about 1,500 rubles per tube. Reviews about the use of the drug for the treatment of synechia in girls are only positive.
If you read on the forum, you can note that many children, according to their mothers, do not have synechiae separated. For fusion of the labia, a gel is prescribed Contractubex(made in Germany). According to the instructions, Contractubex gel is used for gross deformation of the skin, cicatricial changes in the skin, and stretch marks in the postpartum period. I would like to note that nothing is said about breeding synechiae in girls using Contractubex gel. Therefore, you need to think very carefully whether it is worth using this drug in children!
Another frequently prescribed drug for the formation of synechiae of the small lips in a child is ointment Bepanten(contains dexpanthenol). According to the instructions, this ointment is used to accelerate the regeneration of the skin and mucous membranes due to the content of vitamin B5. However, the instructions say nothing about use for fusion of the labia minora in girls!
Solcoseryl- a drug that is also used for adhesions. Yes, the instructions for the drug say that it is used to improve tissue trophism and regeneration. But sticking of the labia is not an indication for the use of this remedy.
Treatment of synechia in a girl with folk remedies
In folk medicine, synechiae in girls is treated with castor oil, applying a small amount of it to the fusion area of the labia minora. It should be noted that castor oil is used not only in gynecological practice. Due to its diverse beneficial properties, castor oil is also used in cosmetology.
Dear mothers, think carefully before using this or that drug that was recommended to you by a friend on the forum. It's best to see a doctor! Only a competent specialist can decide whether it is worth spreading the adhesions between the lips or whether this process can be cured without the use of intervention.
If the urinary tract is involved in the process and there is an acute urination disorder, the synechiae are destroyed surgically, followed by the administration of Ovestin in order to avoid relapses of adhesion. With surgical destruction of the fusion, relapses are observed in 30% of cases.
Synechia in girls, or fusion of the labia (usually the labia minora, less often adhesions occur between the labia minora and the labia majora) is a fairly common problem. Unfortunately, few mothers are aware of how much attention they need to pay to their daughter’s intimate health from birth. They usually don’t talk about this in the maternity hospital, and pediatricians often examine children very superficially. Today we will talk about how to recognize synechiae in a girl, how to prevent and treat it, and also about whether synechiae can go away on their own, without outside intervention.
Synechia: symptoms
Synechiae are visible to the naked eye, and they can be detected by the mother during hygiene procedures or by the doctor during the next examination. When the labia majora are pulled apart, the labia minora remain stuck together, as if glued together, connected by a thin film-membrane. Fusion can occur both along the entire length of the labia and in their lower third. As mentioned above, sticking of the labia majora and minora is also possible. Synechiae block the entrance to the vagina; with complete fusion, the opening of the urethra is not visible.
Complete adhesion of the labia minora leads to difficulty urinating. The girl is crying and straining, clearly experiencing discomfort and even pain. Stagnation of urine leads to the development of infections in the urethra. Symptoms of infection include redness, discharge, rashes, and peeling of the skin in the labia area.
What do synechiae look like and what should it be like? Diagnostics
As can be seen in the figure, the girl’s genitals in normal condition look completely different than in the presence of synechiae.
To determine whether a girl has synechiae at home, it is necessary to conduct a careful examination. Place the baby on her back and, with cleanly washed hands and short-cut nails, spread her labia majora. If there are synechiae, you will see a thin film connecting the labia minora - partly along the length or almost along the entire length. The vagina is not visible, or is partially visible. An attempt to separate the sticky labia brings pain to the girl and she cries.
The doctor conducts the examination in the same way. In order to find out the cause of the appearance of synechiae, he can take smears and cultures, which reveal the pathogenic flora and its sensitivity to antibiotics. It is also recommended to undergo urine and stool tests. It is possible to prescribe tests for hidden urogenital infections: candidiasis, chlamydia, mycoplasmosis, trichomoniasis, gardnellosis, gonorrhea, herpes virus, cytomegalovirus, etc. A pelvic ultrasound may also be required.
Synechia: causes of occurrence
The main reasons for the appearance of synechiae are:
1. Improper intimate hygiene – both insufficient and excessive. With infrequent or poor-quality washing, vaginal discharge accumulates in the labia area, providing a breeding ground for various microorganisms. Pathogenic flora irritates delicate skin, inflammation and irritation of the skin occurs, resulting in fusion. If a girl is washed, on the contrary, too often, using a washcloth, a hard sponge and soap, the sensitive skin of the vulva is injured, microcracks and wounds form on it. While healing, they can grow together.
2. Urinary tract infections . Vulvitis, vulvovaginitis, inflammatory processes in the urinary tract occur as a result of bacterial proliferation. Inflammation causes fusion of the labia. Infection of little girls can occur in the maternity hospital or through household means (from parents). For this reason, you can only use your child’s own hygiene items to care for them. Swimming in natural bodies of water, especially stagnant ones, is also dangerous - neither a swimsuit nor panties for the pool will protect you from possible infection.
3. Allergic reaction , which can occur both from food from the diet of a nursing mother or the child himself, and from chemicals from care products (cream, oil, soap, wet wipes, washing powder, diapers).
In addition, the occurrence of synechiae is facilitated by:
Mom's difficult pregnancy – according to statistics, girls whose mothers had problems during pregnancy (severe toxicosis, intrauterine infections) have a higher risk of developing synechiae;
heredity : parents with a history of adhesions and phimosis can pass on a tendency to tissue fusion to their daughters;
low estrogen levels , which is absolutely normal before puberty for all girls, but leads to fusion only in some. It is the presence of maternal estrogens in the body that protects newborn girls from synechiae. Estrogen levels begin to increase from 7-8 years of age;
wearing too tight, synthetic underwear, diapers . A humid, warm environment provokes inflammatory processes in the vulva area;
dysbacteriosis , in which pathogenic and opportunistic flora are developed in the intestine, often becomes the starting point for the formation of synechiae.
Synechia: how to treat?
The treatment for synechiae depends on the degree of its severity and the reasons that provoked the adhesion.
Some gynecologists are of the opinion that synechiae should be treated only in the case of extensive adhesion that impedes the outflow of urine and/or is accompanied by an infectious process. Otherwise, observational tactics are justified, naturally, taking into account the high-quality hygiene of the girl’s genital organs.
If treatment is necessary, two main methods are used: conservative and surgical.
Conservative method treatment of synechiae involves the use of special ointments and creams that have a local effect on the area of adhesions. The most common recommendation is the use of hormonal (based on estriol, an analogue of estrogen) Ovestin cream; it is carefully applied with a finger with slight pressure (this is important!) on the adhesion area. The standard application regimen is 2 times a day for two weeks. Then the doctor evaluates the effectiveness of the treatment and, if necessary, can extend the course for another two weeks, while the cream is applied once a day. Also, treatment with Ovestin can be combined with the use of ointments such as Contractubex and Traumeel S. For example, the doctor will recommend applying Ovestin once a day and Contractubex 1-2 times for two weeks. At the moment, no serious side effects have been identified from the topical use of Ovestin hormonal cream.
An important part of treatment is adherence to a hypoallergenic diet and, often, anthelmintic therapy. Baths with chamomile, calendula and sage can be helpful.
Conservative treatment is usually sufficient, but to prevent subsequent relapse it is important to establish the causes of synechiae. Tests for infections (bacteriological culture and microscopy of a vaginal smear), dysbacteriosis (stool), as well as for the presence of worms (stool) and pinworms (scraping from the anal folds) will help prevent re-adhesion of the labia.
Surgical method The treatment consists of separating the girl’s labia using a special instrument in the form of a stick with a rounded end under local or, in the case of tight fusion, general anesthesia. Parents should discuss the issue of pain relief with a doctor in advance so that the girl’s psyche is not damaged. Some doctors, unfortunately, still do not consider anesthesia necessary when dividing synechiae. This method is justified in situations requiring urgent intervention, in the absence of effect from hormonal therapy.
Prevention of synechiae
As you know, any health problem is easier to prevent than to treat. The same principle should be followed after treatment of synechiae has already taken place - in order to avoid their relapse.
- You can only wash the girl from front to back.
- When washing, it is better not to use any detergents - neither soap nor gels. Alkaline products cause irritation, drying of the skin and, as a result, the appearance of microcracks. You should use them as rarely as possible; if possible, wash only the anal area with the product. Ordinary tap water is quite enough for high-quality intimate hygiene. If gel or soap is used, then it should be for children, i.e. appropriate acidity, without dyes and fragrances - ideally organic. Don't get carried away with bubble baths either.
- The girl needs to be washed three times a day with warm running water.
- Washing with water is always preferable to using wet wipes or wet toilet paper, even special children's, hypoallergenic, etc.
- You need to wash the girl with your hands, not with a sponge or washcloth.
- After washing the genital area, you should not wipe it, but carefully apply a towel or diaper so that it absorbs excess water.
- A girl should buy underwear exclusively from natural fabrics. 100% cotton is the best option. Panties should be comfortable to wear, the right size, and not tight.
- Children's underwear must be washed separately from adults'.
- Regularly examine the external genitalia of little girls. If you notice the first symptoms of infection (redness, plaque and discharge from the genitals) and synechiae, you should contact a pediatric gynecologist.
- Carefully monitor your diet, avoiding allergens.
- Minimize the use of diapers if possible (especially if the problem of synechiae has already arisen). Change diapers regularly and wash the girl, avoiding irritation.
- If you are prone to the appearance of synechiae, you can lubricate the labia area with almond, sea buckthorn or peach oil after each wash. Malavit gel is also suitable for the same purposes.
- Preventive examinations with a pediatric gynecologist are relevant for girls who have already experienced intimate problems. Of course, the doctor must be kind and attentive so as not to cause psychological trauma to the girl.
Is it possible to do without treatment?
Treatment in such a delicate area is scary for mothers, and this is not surprising. On the one hand, it is scary to start a pathological process, but on the other hand, it is not clear whether the problem is really serious and requires immediate intervention? Any forum for mothers testifies: often treatment does not become a panacea, and young patients undergo surgical separation of synechiae or are exposed to hormonal and other agents repeatedly.
What do the doctors say? As in many other cases, their opinions were divided.
Practice shows that usually a mother who comes to a pediatric gynecologist with the problem of synechiae hears that it is very dangerous and in the future can harm the girl’s reproductive system: lead to infertility or miscarriage. In addition, synechiae are considered a risk factor for the development of chronic inflammatory diseases of the genitourinary tract. Thus, doctors in children's clinics almost always recommend active treatment of synechiae, even with partial adhesion of the labia, which does not cause discomfort to the child.
However, there is another way of looking at this issue. Doctors from one of the most popular Russian medical sites - the Discussion Club of the Russian Medical Server - consider treatment of synechiae justified only in particularly serious cases. Here are some quotes from Rusmedserver specialists.
V.V. Samoilenko, executive director of the All-Russian public organization “Association of Russian Nurses” (RAMS), specialist in the field of evidence-based medicine :
“With an asymptomatic course of the process, no additional help, other than ordinary hygiene, is required. Since the vast majority of cases resolve independently without consequences, observational tactics are justified.
And only in the case of severe symptoms - extensive adhesion that impedes the outflow of urine and/or the addition of an infectious process may require treatment.”
G.A. Melnichenko, Professor of the Department of Endocrinology of the Moscow Medical Academy, President of the Moscow Association of Endocrinologists, Director of the Institute of Clinical Endocrinology of the Scientific Research Center of the Russian Academy of Medical Sciences, Vice-President of the Russian Association of Endocrinologists, Academician of the Russian Academy of Medical Sciences:
“It is not entirely clear what is the reason for the continuous attention to a phenomenon that is frequent and not necessary in uncomplicated cases in girls - synechiae, and why strange aggressive tactics that traumatize the child are persistently chosen? How does synechia hinder your child? Did you know that they will disappear on their own during adolescence?”
"This theme<прим. лечение синехий>rises with a frequency of about once every two weeks, and every time we talk about the safety of Ovestin and the unnecessaryness of painful manipulations on the genitals without reason.”
I agree with the opinion of Rusmedserver specialists and A.V. Borisova, head of the gynecology department of the Moscow Doctor company, obstetrician-gynecologist, ultrasound doctor, Ph.D. :
“Nowhere in the world has synechia been shared for little girls for a long, long time. Because they go away on their own with the onset of puberty. Female sex hormones begin to be produced, the mucous membrane in the vulva area thickens, natural lubrication of the labia begins to be produced, and synechiae disappear on their own in the vast majority of cases. Yes, about 15-20 years ago, in other countries, synechiae in girls was forcibly separated, but then research was carried out, and the tactics completely changed.
The indication for mechanical separation of synechiae in girls before puberty is disturbances in urination (urinary retention, which occurs in less than 0.1% of cases; recurrent urinary tract infection, which is rare). Quite often, the stream of urine in such girls goes like in boys - sharply upward. But this is not a reason for mechanical destruction of synechiae.
There is no 100% effective way to prevent the appearance of repeated synechiae in girls after their mechanical separation. They try Ovestin and various creams and ointments, but in a large percentage of cases, as statistics and practice show, this does not help. Your daughter is another example of this.
What should you do now? Nothing. Leave the child alone, otherwise she may develop a psychological complex from the fact that they are always doing something to her there. New synechiae will definitely appear. Do not panic! If the girl does not experience any subjective discomfort when urinating (and this is easy to guess from the baby’s behavior), she will not need anything other than basic hygiene measures. When she grows up and begins to produce female sex hormones and has a regular menstrual cycle, take her to the gynecologist. If the synechiae persist, it will be possible to separate them mechanically. And their own hormones will minimize the risk of their reappearance. But just don’t separate the synechiae anymore now (unless she has recurrent urinary tract infections or discomfort when urinating)!!! The more times you mechanically separate the synechiae now, the greater the risk of scar tissue formation in the labia area, the higher the likelihood of the formation of increasingly dense synechiae, the less the likelihood of their spontaneous divergence upon achieving sexual intercourse.”
and known to most mothers E.O. Komarovsky :
Thus, we definitely advise mothers to immediately contact a pediatric gynecologist in case of extensive sticking of the girl’s labia, which causes discomfort and impedes the flow of urine. Symptoms of an infectious disease will also be an indication to visit a doctor. As for other cases, parents should use common sense and follow the recommendations of those specialists whom they really trust. The approach of some doctors in children's clinics to the problem of synechiae, unfortunately, is often unjustified: traumatic for the girl's psyche and ineffective in terms of treatment.
Remember the importance of preventing synechiae. By eliminating the main factors that contribute to the adhesion of the labia, you will certainly prevent the initial or recurrence of the problem. Proper hygiene, monitoring the condition of the baby’s genitals and healthy nutrition are an invaluable contribution to the gynecological health of the girl.
Diseases of the genitourinary system can occur not only in adult women, but also in newborn girls. Every tenth person is born with fused labia; in others, adhesions occur before the age of 10 due to infection or poor hygiene.
Synechia in girls complicates the excretory function, and in severe form can lead to weakened reproductive function in adulthood. Treatment of pathology should be carried out under the supervision of a pediatric gynecologist.
Synechia is the congenital or acquired fusion of the small genitalia (less often the major) in girls from birth to ten years of age.
Normally, a girl’s external genitalia consists of 2 pairs of folds formed by the skin and mucous membrane, not connected to each other. If you move them apart, you can see the entrance to the vagina. The mucous membranes have a uniform pink color.
With synechia, a thin film forms between the labia, which connects the minor, major or minor folds. The mucous membranes and skin have obvious signs of irritation: redness, peeling.
Splicing can be:
- partial - only the entrance to the vagina is closed;
- complete - the genital fissure and the urethra are completely closed.
Synechia can occur in girls born after a difficult pregnancy. In addition, children with severe allergic reactions of any nature are at risk.
The disease itself does not pose a threat to the child’s life, but the accumulation of contaminants in the intimate area and a warm environment create favorable conditions for pathogenic microorganisms, which ultimately leads to infection of the genitourinary system. The consequences may be:
- inflammation;
- cystitis;
- difficulties during pregnancy;
- spontaneous miscarriages;
- infertility.
If the fusion does not exceed 5 mm, it is absolutely safe for the child and usually does not require medical treatment (observation by a gynecologist is mandatory). This pathology very often disappears on its own after the body begins to produce female sex hormones.
Possible causes of fusion
Synechiae can be detected in a newborn girl due to a lack of the female hormone estrogen in the mother during pregnancy.
Congenital adhesions are the most common type of pathology. Acquired fusion occurs due to frequent irritation of the mucous membranes and improper regeneration, as a result of which adhesions form between the labia. This may be caused by:
- Improper hygiene.
Some mothers, in pursuit of cleanliness, do not know the limits. Washing girls with soap after each urination and defecation leads to irritation of the genitals. Even the mildest product for children contains alkali, so pediatricians recommend washing children with soap or gel only once a day.
- Underwear.
Due to wearing tight or synthetic panties, mechanical irritation of the labia occurs, aggravated by sweating with subsequent fusion.
- Inflammations and infections of the reproductive system.
Microbes get into a child's vulva when hygiene is neglected, when visiting swimming pools, bodies of water, or sharing a towel with a parent. Such diseases often occur hidden, timely treatment is not carried out and the formation of adhesions begins.
- Allergy.
Intolerance to foods and household chemicals causes irritation on the child’s skin and mucous membranes, including the genitals.
- Fast tissue regeneration.
Irritation of the mucous membranes can occur due to infection with helminths and dysbacteriosis.
Signs of synechia in a girl
A mother can detect synechiae in a girl during an examination: the child’s labia are tightly connected to each other and when she tries to open them, the baby cries.
Please note that during such manipulation you need to wash your hands, trim your nails short and do not make any effort so as not to damage the delicate skin and cause infection.
In addition to external signs, pathology can be suspected by several indirect signs:
- crying while urinating;
- itching, rash or redness on the genitals;
- fear of urination;
- change in the direction of the urine stream;
- frequent leakage of urine;
- atypical appearance of the genitals.
If such symptoms appear, it is necessary to show the girl to a pediatric gynecologist.
You can learn about how to identify synechiae in children and the hygiene features to prevent the problem from the video.
Diagnostic features
To diagnose fusion of the labia in a girl, a gynecologist needs a visual examination, but to determine treatment tactics a number of laboratory tests are necessary:
- mucosal smear to determine microflora;
- antibiotic sensitivity smear;
- analysis for sexually transmitted infections: chlamydia, candidiasis and others;
- examination of feces for helminths;
- urine culture.
If changes in the internal genital organs are suspected, an ultrasound examination of the pelvis is performed.
Treatment of synechiae in a child
The tactics for treating synechiae in girls depends on the degree of fusion of the labia. If it is minor and does not interfere with physiological processes, the child is not treated, but the gynecologist regularly monitors the condition of the genital organs.
Drug treatment
Pediatric gynecologists prefer to treat synechiae in children using a conservative method. If the film becomes dense, its size increases, or discomfort appears when urinating, the child is prescribed ointments and creams that promote independent dilation of the labia.
General application rules:
- the child’s genitals are washed with warm water without soap;
- put the girl on her back and spread her legs;
- Apply a thin layer of the product to the fused area with your finger (it is prohibited to use cotton pads or swabs);
- diaper and underwear are put on only after the drug has been absorbed.
- Preparations should not be applied to healthy tissues.
The course of treatment is usually 2 weeks, after which the labia separates on its own or the gynecologist separates them with his hands. Doing such manipulations at home is dangerous to health. In rare cases, the therapeutic course has to be repeated.
Several ointments and creams are used to treat synechiae: Ovestin, Contratubeks, Malavit, Traumeel-S.
Cream Ovestin
Ovestin is a cream containing the female hormone estriol.
The product is eliminated from the body within 18 hours, so it is enough to use it once a day, preferably at night. To treat the genitals, 5 mm of cream is needed, it is carefully rubbed into the adhesions, and then the small lips are massaged with large circular movements.
Ovestin can be used for 14-20 days; if the drug was ineffective, the course can be repeated only after 10 days.
When used correctly, Ovestin cream does not affect the child’s hormonal levels. Rarely, thin hairs may appear on the vulva, discoloration of mucous membranes and slight enlargement of the mammary glands (the side effect disappears after stopping treatment).
Contratubeks
To treat synechiae in girls, Contratubex ointment is used. The drug contains components that help resolve keloid scars, adhesions, scars after operations and injuries:
- heparin;
- onion extract;
- allantoin.
Contratubeks can be used in combination with Ovestin once a day. Many parents do not risk using hormonal drugs to treat young children. In this case, you can get by with one Contatubex, but the period of use increases to 3 months.
Apply 1 cm of Contratubex to the fusion site and rub in gently.
After completion of conservative treatment, the gynecologist examines the child once a month for a year.
Surgical intervention
Dissection of the labia is performed in several cases:
- ineffectiveness of conservative treatment;
- difficulty urinating;
- complete merging.
The operation is usually performed after local anesthesia with lidocaine application (with complete fusion under general anesthesia) and lasts several minutes.
After surgery, it is necessary to take special care to maintain hygiene and treat the genitals with hormonal ointments, anti-inflammatory and antibacterial drugs.
Treatment of infants at home
If there is a small fusion of the labia without complications, it is permissible to treat the girl at home. To do this, use sitz baths with warm decoctions of soothing and anti-inflammatory herbs: chamomile, calendula, sage, string. The duration of the procedure should not exceed 10 minutes, and the temperature of the liquid should not be 37 degrees.
After the bath, apply sea buckthorn, peach oil or unflavored baby cream to the genitals.
While applying the cream, you can do a light massage: carefully spread the labia to the sides, pressing slightly on them. Manipulations should be carried out with clean, warm hands without nails.
Preventive measures
After surgical dissection and spontaneous disappearance of synechiae, the possibility of re-fusion remains (in approximately 30% of cases).
To prevent fusion in healthy girls and after medication or surgery, the following recommendations should be followed:
- Wash daily with warm running water. Movements should be directed from front to back to avoid introducing germs under the labia.
- If you are prone to allergic reactions, you need to adjust your diet, change the household chemicals you use (if possible, avoid them), and change medications.
- Choose suitable underwear made from natural fabrics. It should be changed daily and washed separately from adult clothes.
- If possible, avoid diapers.
- For intimate hygiene, use baby products with neutral Ph. The gel is used only before bedtime.
- Carefully examine the child’s genitals and, if pathology is suspected, be examined by a pediatric gynecologist.
- Do not use creams or powders with fragrances to treat the girl’s genitals.
Synechia is a fairly common pathology among girls under 8-10 years of age. In 80% of cases, fusion of the labia goes away on its own by puberty and does not bother the child.
An anatomical disorder can lead to inflammation and infection of the pelvic organs, so such children should be regularly examined by a pediatric gynecologist.
Most parents are not even aware of synechiae of the labia minora in girls. They don’t talk about this in courses for expectant mothers. It is difficult for a mother, even a woman, to determine whether her daughter has synechiae or not.
What do synechiae of the vagina and labia minora look like in girls?
Synechia, simply put, is a fusion. Synechia of the labia minora is the fusion of the labia minora in a girl. Possible fusion of the labia minora with the labia majora. Fusion can be complete or partial.
To examine your daughter for the presence of synechia, you need to :
· wash your hands well with soap
· nails should be cut short
· put the baby on her back
· Gently spread your legs and carefully examine the genitals
Having opened the labia majora, the mother will see that the labia minora are tightly pressed to each other and a film has formed between them. The vagina is not visible at all, or only part of it can be seen. When I try to separate the jaws, nothing happens. This brings pain to the baby and the child begins to cry.
IMPORTANT: With a normal structure of the labia minora, the gap is large, the vagina is clearly visible. The labia minora look like petals and are separate from the labia majora.
Signs of synechia in girls
IMPORTANT: The main sign of the presence of synechia in a girl will be problems with urination. The child will cry and strain. Relief comes only after urination. The situation worsens in the evenings. The baby practically cannot sleep.
Signindicating the possible appearance of synechia are:
· redness of the baby's genitals, the presence of a small rash
· When washing, there may be painful sensations, the girl will cry
· Synechia is also indicated by the fact that when urinating, urine rises in a stream upward, like in boys
· constant leakage of urine, the child went to the potty, but his panties were always wet
Synechia in girls, photo
The first photo shows the normal structure of the genital organs. The second photo clearly shows the complete fusion of the labia minora.
Synechia in infant girls
Almost from the first days of life, girls can have fused labia. It is believed that The cause of this disease is low levels of sex hormones. This should not alarm parents. Since the absence of sex hormones before puberty is the norm.
Up to about 8 years of age, relapses of the disease are possible. As a girl grows up, the genital mucosa becomes less susceptible to external irritants and more dense. And it hardly grows together.
Causes of synechia in girls
The reasons that can provoke synechiae are:
· food allergies in a child to certain foods in the diet of a baby or mother who is breastfeeding
· household allergies can occur to diapers, powder, cream, soap, napkins, oil
· insufficient washing
· washing too often
· use when washing soap
· improper washing
· genitourinary system infections
· hormonal medications taken by the mother while the baby is pregnant
· dysbacteriosis
· worms
In order to find the cause of the formation of synechiae,the specialist will prescribe a series of tests :
· vaginal smears
· blood and urine test
· feces for dysbacteriosis and worm eggs
· scraping for enterobiasis
Breeding synechiae in girls
IMPORTANT: The earlier synechiae are detected, the easier it is to breed them. At the very beginning of the disease, the film is thin and transparent. And when fully fused, it becomes dense, the body perceives the genital gap as a wound, and without surgical intervention it cannot be separated.
· You cannot do this on your own; you can only harm the child. If you suspect synechia, you should seek help from a pediatric gynecologist.
· It is believed that synechiae should not be touched at the initial stage, but should be diluted only when the fusion brings discomfort to the baby
Treatment of synechiae, dissection of synechiae in girls
· The dissection of synechiae in girls is done by a pediatric gynecologist. This procedure is performed using a scalpel and takes a few seconds. The manipulation is painful and requires special care for the baby’s genitals
· To relieve painful urination and wound healing, sitz baths, lotions and antibacterial ointments are recommended
IMPORTANT: Dissection does not protect against repeated relapses. The labia minora may grow back together. Parents have the right to refuse this method of treatment, but with complete fusion, when urination is impaired, this is the only way to help the girl.
· give up diapers
· carefully monitor your baby’s personal hygiene
· lubricate the labia with baby cream and vegetable oil
· do air baths as often as possible.
How to treat synechiae in girls at home?
Treatment of synechiae at home is possible only with partial and uncomplicated fusion. To do this, use warm sitz baths with the addition of medicinal herbs such as chamomile, 
Video: When to treat synechiae in girls - Dr. Komarovsky
Video: How to treat fusion of the labia - Dr. Komarovsky
Video: Pediatrician Plus - Synechia (fusion of the labia minora) in girls
