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Complete labial fusion and urinary retention in a postmenopausal woman
Fusão labial completa e retenção urinária em mulher na pós-menopausa
1. Serviço de Ginecologia/Obstetrícia do Centro Hospitalar de Entre o Douro e Vouga. Portugal.
Abstract
Complete labial fusion is a rare cause of urinary retention and typically presents at the extremes of age. Oestrogen deficiency, chronic inflammation, local trauma and lack of sexual activity may predispose to the appearance of labial fusion. The authors present a recurrence case of a postmenopausal woman with urinary retention associated with labial fusion.
Keywords: Labial fusion; Urinary retention; Menopause
Resumo
A fusão labial completa é uma causa rara de retenção urinária e com apresentação típica nos extremos da idade. A deficiência de estrogénios, a inflamação crónica, o trauma local e a ausência de atividade sexual podem predispor para o surgimento da fusão labial. Os autores apresentam a recorrência de um caso de uma mulher na pós-menopausa com retenção urinária associada à fusão labial.
Palavras-chave: Fusão labial; retenção urinária; menopausa
Description
Labial fusion, which is also called labial adhesion or vulvar fusion, is defined as when the labia minora or majora undergoes partial or complete adherence1. Labial adhesion is a rare cause of female voiding difficulty and it is more commonly seen in the extremes of age2. The aetiology is thought to be chronic inflammation, oestrogen deficiency, local trauma and lack of sexual activity3),(4.
A 63-year-old woman presented to the emergency department with abdominal pain and urinary retention for over 24 hours. In the previous 3 months, she complained with incomplete voiding and in the previous days, she had dribbling of urine.
Six years ago, the patient had undergone surgical correction for labial fusion. She was nulliparous, had been sexually inactive for 20 years, and reported menopause 15 years ago. Physical examination revealed a fused labia minora at the midline, obscuring the vestibule, vagina, and urethral meatus (Figure 1). No vulvar lesions suspicious of malignancy or lichen sclerosis were observed.
Under local anaesthesia, the fused labia were separated by blunt dissection along the line of fusion, with spontaneous discharge of urine (Figure 2). The patient was catheterized for 24 hours post-operatively. On discharge, the patient was advised to apply vaginal oestrogen cream and dilate the vagina digitally and regularly after the procedure. Recurrence can occur in 20% of patients who undergo surgical or manual separation5.
After 24 months of follow-up, the patient had no complaints during micturition and no recurrent labial fusion was observed.
Author’s contribution
Conceptualization: Patrícia Gomes Ferreira, Vânia Ferreira and Foo Kok Mak. Methodology: Patrícia Ferreira. Writing - Original draft: Patrícia Ferreira. Writing - Review: Vânia Ferreira and Foo Kok Mak.
Conflicts of interest
There are no conflicts of interest.
Patient consent
The patient gave permission to use clinical information and photographic material in this publication.
References
1. Üstüner I, Avsar AF. Labial adhesion with acute urinary retention secondary to Bartholin's Abscess. Low Urin Tract Symptoms 2012;4:106-8.
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2. Norbeck JC, Ritchey MR, Bloom DA. Labial fusion causing upper urinary tract obstruction. Urology 1993;42:209-11.
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3. Juma S. Urinary retention in women. Curr Opin Urol 2014;24:375-9.
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4. Laih CY, Huang CP, Chou EC. Labial adhesion in a postmenopausal female: A case report. Medicine (Baltimore). 2020 Jun 26;99(26):e20803. doi: https://doi.org/10.1097/MD.0000000000020803. PMID: 32590764; PMCID: PMC7329012.
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5. Singh P, Han HC. Labial adhesions in postmenopausal women: presentation and management. Int Urogynecol J 2019;30: 1429-32. doi: https://doi.org/10.1007/s00192-018-3821-1.
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