Atypical Presentations of Labial Synechiae: A Case Series of Three Pediatric Patients

Background

Labial synechiae is a common condition in prepubertal girls characterized by adhesion of the labia minora. Typically, these adhesions originate from the posterior fourchette and advance anteriorly. While most cases are asymptomatic, some present with urinary symptoms. This case series highlights three unusual presentations of labial synechiae with distinct urinary manifestations.

Methods

We retrospectively reviewed three pediatric cases of labial synechiae with atypical presentations seen at our tertiary care center between January 2022 and December 2023. Patient demographics, presenting symptoms, physical examination findings, treatment modalities, and outcomes were documented.

Results

The three cases (ages 3, 4, and 5 years) presented with distinct urinary symptoms: bifid urinary stream, post-void dribbling, and dysuria with urinary retention, respectively. Notably, all three demonstrated atypical patterns of labial adhesions: mid-labial fusion with patent anterior and posterior openings, anterior fusion with posterior patency, and asymmetric lateral fusion, respectively. All cases were successfully managed with a combination of manual separation and topical estrogen therapy, with no recurrence at 6-month follow-up.

Conclusion

This case series highlights the diverse clinical presentations of labial synechiae beyond the classical pattern. Clinicians should consider labial synechiae in the differential diagnosis of various urinary symptoms in prepubertal girls and perform careful genital examination. Early recognition enables simple, effective treatment and prevents unnecessary investigations and psychological distress.