Labial_fusion

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Labial fusion in gynaecology,Fusion oR confusion !! : 

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

Labial Fusion (LF) : 

Labial Fusion (LF) Anxiety Dysparonea Dribbling of urine UTI, asymp. Bacteruria AIM: CLEAR THE CONFUSION

LABIAL FUSION : 

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

Diagnosis : 

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

DD : 

DD Rokitansky LF Imperforate hymen

AETIOLOGY OF LF : 

AETIOLOGY OF LF By age By the cause

Inflammatory (in children) : 

Inflammatory (in children) (Vulvitis or vulvo-vaginitis poor perineal hygiene seborrhoea atrophic dermatitis pinworms

Labial fusion in children : 

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 cream…how long? BUT Sugical treatment can cause high recurrence, traumatic, GA - hygiene, swaps or biopsy (Rare)

D.D. of labial fusion in children : 

D.D. of labial fusion in children Developmental abnormalities (newborn) Infection ( Vulvo-vaginitis, pin warms ) LS CSA (child sexual abuse) Hypo-estrogenaemia

Posterior labial fusion in children(sexual abuse) : 

Posterior labial fusion in children(sexual abuse) You must be familiar with the exam. of genitalia of young girls Over diagnosis of CSA

Traumatic : 

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

Postpartum labial fusion : 

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

Female genital mutilation : 

Female genital mutilation Traditional, Religious, Social Humiliation in some African countries !!!!!!!!!

Procedure : 

Procedure

INFIBULATION : 

INFIBULATION

INFIBULATION : 

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

OTHER CAUSES : 

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

Primary genital Herpesvesicles ulceration : 

Primary genital Herpesvesicles ulceration Proper treatment prevent LF – involve GUM

Pemphegoid : 

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

Lichen sclerosis : 

Lichen sclerosis

LS : 

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

Postmenopausal : 

Postmenopausal

Congenital (V. RARE) : 

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 babies……confusion

CONCLUSION : 

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

Slide 29: 

THANK YOU AHMED ZAKI

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