Labial fusion in gynaecology, Fusion oR confusion !! AHMED

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Labial fusion in gynaecology,Fusion oR
confusion !!

• AHMED ZAKI- MD, MRCOG
• Consultant OB/GYN
• Chairman of the Scientific Committee
• Bakhsh Hospital Al Sharafyia. Jeddah, Saudi
  Arabia

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Labial Fusion (LF)

• Anxiety
• Dysparonea
• Dribbling of urine
• UTI, asymp. Bacteruria
• AIM
• CLEAR THE CONFUSION

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LABIAL FUSION

• Definition
• partial or complete adherence of the labia minora
  or majora.
• Incidence
• (occur in all age groups)
• Patho-physiology
• -Interruption of the dermo-epidermal junction
• -combination of factors hypoestrogenaemia local
  irritation, inflamm or trauma
• -Auto-immune

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Diagnosis

• Clinical diagnosis
• No specific lab or radiology required
• You must identify separately L.maj, L.min, hymen
  vagina .why?
• Premature girls

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DD
Rokitansky
LF
Imperforate hymen
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AETIOLOGY OF LF

• By age
• By the cause

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Inflammatory (in children)

• (Vulvitis or vulvo-vaginitis
• poor perineal hygiene
• seborrhoea
• atrophic dermatitis
• pinworms

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Labial fusion in children

• Incidence
• (rare before 3 months uncommon after age of 5
  years)
• It is a common ped. Problem (1.8- 3.3)
• Associated with hypoestrogenaemia
• It can be a marker of LS or vulval dis or CSA
• Treatment
• -Estrogen creamhow long? BUT Sugical
  treatment can cause high recurrence, traumatic,
  GA
• - hygiene, swaps or biopsy (Rare)

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D.D. of labial fusion in children

• Developmental abnormalities (newborn)
• Infection ( Vulvo-vaginitis, pin warms )
• LS
• CSA (child sexual abuse)
• Hypo-estrogenaemia

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Posterior labial fusion in children(sexual abuse)

• You must be familiar with the exam. of genitalia
  of young girls
• Over diagnosis of CSA

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Traumatic

• sexual abuse ( only in prepubertal girls)
• saddle injury
• Female genital mutilation (elective)
• labial lacerations ( postpartum)

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Postpartum labial fusion

• Extremely rare
• Multiple lacerations heals spontaneously
• No EB management of multiple lacer.
• separation of adhesions
• Estrogen cream
• Amniotic membrane grafting in recurrent cases

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Female genital mutilation

• Traditional,
• Religious, Social
• Humiliation in some African countries !!!!!!!!!

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Procedure
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INFIBULATION
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INFIBULATION

• Complications
• Re-infibulation
• Labour delivery
• Prohibition of female cicumc. act 1985
• RCOG guidelines
• RCN

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OTHER CAUSES

• Infections
• HSV (primary)
• Gonorrhea (rare)
• Autoimmune (all ages)
• Pemphegoid (Cicatricial Pemphegoid)
• Lichen sclerosis (children adults)
• Hypo-estrogenaemia
• Familial (only case report)

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Primary genital Herpesvesicles
ulceration

• Proper treatment prevent LF involve GUM

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Pemphegoid

• Bullous Cicatricial
• IgG auto-antibodies against dermo-epidermal
  complex
• Rare in children
• Topical or systematic steroids
• Mis-diagnosed as herpes(B) or LS(C)
• Diag. by Bx immumoflurectnt tech

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Lichen sclerosis
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LS

• Can occur at any age (children men)
• Steroid cream
• Long term follow up
• Surgical correction is an option in severe cases

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Postmenopausal
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Congenital (V. RARE)

• CAH (Clitoral enlargement and labial fusion)
• As a part of ambiguous genitalia
• Maternal ingestion of androgens
• Androgen secreting tumour during pregnancy
• Premature babiesconfusion

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CONCLUSION

• FGM is not a LF it is mental confusion
• The confusion is treating the fusion not the
  CAUSE (age will help)
• Increased knowledge of various causes of LF can
  help to make the correct diagnosis without any
  confusion. This is simply because
• EYES CAN NOT SEE WHAT THE BRAIN DOES NOT KNOW

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THANK YOU
AHMED ZAKI