Severe Labial Agglutination Release in a Postmenopausal Woman

Labial agglutination occurs when the labia minora have become fused in the midline through either filmy or dense adhesions, forming a raphe. This condition is typically seen in pre-pubertal girls; however, there have been cases reported in the literature of labial agglutination in postmenopausal and reproductive aged women. Labial agglutination has been associated with local irritation and inflammation in the setting of a hypoestrogenic state. Topical treatment is usually recommended prior to manual separation. However, some postmenopausal women have been refractory to conservative management, and surgery may then be required. We present a case of a 79-year-old Caucasian gravida 3 para 3 who was referred for treatment refractory labial agglutination for 3 years. The patient’s complaints included a small trickle escaping from the introitus during urination and the sensation of little urinary control. The patient underwent an exam under anesthesia. Gentle blunt dissection with a lacrimal dilator easily separated the labia minora down the visible midline fusion line (raphe). Bimanual exam then revealed a 12-week-sized enlarged uterus confirmed on ultrasound to be an 8 × 8 × 7 cm irregular mass concerning for uterine cancer. Proceeding to an operative release of severe labial agglutination can relieve patient discomfort and frustration when estradiol therapy has failed. In addition to alleviating symptoms, releasing labial agglutination can also provide the gynecologist access to critical screening procedures such as cervical cytology or a bimanual exam, all of which could lead to a diagnosis or pre-cancerous or cancerous lesions.