Sinechia in girls

Sinechia in girls is a very delicate problem of early age. Many parents do not even realize that their daughter has adhesions of the labia. Therefore, such a diagnosis from the mouth of a pediatric gynecologist, who will examine a child at the medical board when applying for kindergarten or earlier, can frighten adults. Should we be afraid of Synechia and how to treat them, we will tell in this article.

Sinechia in girls is a rather common occurrence. Only on paper, medical statistics look optimistic, indicating that the fusion of the labia occurs in 3-4% of babies. In fact, in the practice of a particular pediatrician, at least 25-30% of nursing girls and older babies are found, who in varying degrees have the clinical symptoms of this disease. It’s just that not every doctor considers them serious and worthy of entry into a medical card, rightly "writing off" them on the age characteristics of the girl's body.

Synechia is the fusion of the genital lips. Big lips of the labia can grow together. But more often there is a combination of small genital lips, usually in the lower third. Less often, they grow together over the entire length. And it is not often between the large and small labia that grow together.

Often the disease does not cause discomfort to the child. But with pathological fusion, when not only the entrance to the vagina, but also the outlet of the urethra is closed, there may be associated inflammatory disorders that will bring the girl a lot of discomfort.

Usually at this age, puberty begins and the problem is solved by itself. The greatest number of such diagnoses is made at the age of 1 year, when parents bring their daughter to a large medical examination, and also at 2-3 years, when documents are issued in the kindergarten. A visit to a pediatric gynecologist is a must.

Translated from the Greek word "synechia" means "continuity, connection." Humanity has long known about the disease, but it was described in detail only in the twentieth century. Until now, there have been heated debates between doctors and scientists as to whether synechiae should be considered a disease at all or whether it is sufficiently attributed to the category of physiological states. The question is really controversial. Indeed, for most female children under the age of 7, synechiae are as natural as physiological phimosis in boys.

The causes of the labia are not known for sure. But modern experiments and studies indicate the most likely link between the development of synechiae and the production of sex hormones. The newborn girl's own sex hormones are practically absent, but there is an excess of estrogen borrowed from the mother (the female sex hormone). It provides the elasticity of the labia, for this reason, for a newborn and a girl - a baby, up to half a year, synechiae usually do not develop.

After 6 months, maternal estrogen ends, and its baby is not enough. The labia are no longer elastic, and under the influence of adverse factors can very easily be connected. These factors include:

• allergic reactions - their skin manifestations that affect the genital area.When this occurs, the inflammatory process in the damaged skin, and during healing the labia majora unite;

• inflammatory processes of bacterial origin - the mechanism of occurrence is the same. Bacteria that cause inflammation of the urinary tract can get to the genitals as a result of hygienic errors, such as improperly washing the baby;
• mechanical irritation of the genital organs - if the child wears linen and clothes made of synthetic fabric, then the likelihood of irritation and then healing with adhesion is rather high;
• chemical irritation - if the child’s laundry is washed with aggressive laundry detergents, not intended for children, if the girl doesn’t change the diaper often enough or wash it with soap several times a day;
• non-obvious reasons - a situation where there are synechias, and the above factors were absent.

Identifying the cause as such does not play a big role in establishing the diagnosis of "synechia." The medical approach and treatment of the problem does not depend on the specific reason for the adhesion.

The fusion can develop several months, and sometimes it occurs in a matter of days. Usually this process is not felt by the child. The girl's behavior does not change, she has no pain, itching, inconvenience. That is why it is usually impossible to detect synechiae at the initial stage. The intimate "disturbance" becomes apparent when the fusion has already occurred.

The exceptions are cases when the labia intergrow in the upper third, partially or completely blocking the urethra. In this case, each urination gives the child uncomfortable sensations, but due to the absence of severe or severe pain, the child may not be too obvious to others that he is worried about something. Attentive parents may notice that when urinating, the girl cramps, hesitates, blushes, and begins to worry. But these symptoms will not be bright and specific, and therefore may well also go unnoticed.

Synechiae become apparent when a thick film forms between the labia. In the very middle of this partition, the so-called median strip is visible - that same zone of fusion. When fusion of the labia minora is closed the entrance to the vagina - a few millimeters, a third, half or full. If there is a fusion of large and small lips, then it is usually observed symmetrically on both sides. If the synechia is complete, then it is impossible to discern the entrance to the urethra.

Complicated synechia may be accompanied by redness of the external genital organs, inflammation by type of vulvitis or vulvovaginitis. There may be discharge from the vagina with a sharp and unpleasant sour or purulent smell. This process is accompanied by pain and severe itching, the child's behavior changes, anxiety increases, especially after each urination. The temperature of the child may slightly increase only in case of complicated synechias. In all other situations, she is at a normal level, the child’s well-being is good, her appetite, sleep, and synechia activity are not affected.

If desired, parents can quite easily see the synechia. To do this, do not need special tools and accessories: the film that connects the labia, is quite well distinguishable.

Pediatric gynecologist is a specialist who today is in almost every children's clinic.

At the reception, the doctor will examine the external genitals of the child, assess the degree of adhesion, and prescribe several additional tests that will allow one to judge whether the problem is more physiological or whether it is a complicated synechia. You will need to pass the following tests:

• seeding on urogenital infections;
• seeding to determine the presence of bacteria and their sensitivity to certain antibiotics;
• general blood and urine tests;
• ultrasound examination of the pelvic organs (rarely prescribed, only if the adhesion is extensive and there are visual signs of inflammation).

If a doctor on visual examination finds a small adhesion size without signs of inflammation, then he will most likely not prescribe additional studies.

In most cases, synechia do not pose any danger to the life and health of the girl. However, with full adhesion or overlap of the urethra adhesions under the film creates a closed space, which accumulates and vaginal discharge, and urine residue. Any enclosed space is an excellent breeding ground for various pathogenic and conditionally pathogenic bacteria. If you ignore this, the inflammation will begin to "rise" higher, and the important reproductive organs of the child will be affected - the uterus, the appendages, the ovaries.

In this way, Complete and complicated synechia are usually treated. The same cannot be said about all synechias. If the film does not close the vagina or urinary canal, if there is no inflammation, it may well be left alone. Only systematic observation is prescribed to the child, because all doctors are well aware that 90% of synechias dissolve on their own by the age of 7-8, when puberty begins. As soon as the level of sex hormones is sufficient, the external genitals will become denser, more elastic, and the fusion will disappear by itself.

With synechias that do not create obstacles to the vaginal entrance and the urethral inlet, and also do not cause inflammation, itching and burning, no treatment is required. It is enough to keep the situation under control, visiting the pediatric gynecologist twice a year, who will assess the degree of fusion and dynamics. Treatment is required for girls who have not started to solve the problem after 8 years, as well as babies who have an adhesions process in the region of the labia at an earlier age, causing unpleasant sensations, causing inflammation and preventing the release of vaginal secretions and urine.

Treatment measures for synechiae always begin with gentle conservative treatment. There are no reasons for an emergency operation with this diagnosis. It is not necessary to hospitalize the girl, synechiae can be perfectly treated at home.

In order to compensate for the deficiency of the female sex hormone, prescribe an ointment that contains estrogen. Usually used cream "Ovestin". The course of treatment is usually 5-6 weeks. The scheme looks like this:

• The first 14 days carry out external treatment of the labia “Ovestin” twice a day - in the morning and in the evening.
• The second 14 days external treatment with this drug is carried out only once a day, for example, in the morning. In the evening, ordinary baby cream or liquid paraffin is used for lubrication. Sea buckthorn or peach oil can also be used.
• Over the next week, use only butter or baby cream.

It is very important to put "Ovestin" correctly. This should be done solely with a finger, not a swab or cotton buds. The cream should not fall on the adjacent tissues with soldering; when applying it only to the place of fusion, it should be easy to press with a finger. This pressing effect is of paramount importance to the separation process.

After such a course, the result is evaluated. In case of a positive outcome, synechiae are divided under the influence of "Ovestina". If negative, no separation occurs. If questionable, the separation occurs only partially.

With full separation, prescribe a course. «Contractubex». Ointment or gel "Kontraktubex" promotes the formation of a smooth and elastic tissue, prevents re-fusion. They lubricate the labia twice a day - in the morning and in the evening, applying a gel or ointment with a thick layer.

It is often enough to find angry parental reviews that Contractubex did not help the child with synechia. Experts believe that this is possible only if the drug was used incorrectly - at the initial stage of treatment, for example, even before the separation of the labia or incomplete separation. A prerequisite for successful treatment of such gel - complete preliminary separation of adhesions.

In the presence of an inflammatory process, treatment will be somewhat different in its initial and final parts.

After each spot of inflammation smeared ointment "Bepanten". After the redness disappears, you can proceed to the course described above.

Sometimes treatment with Ovestin is supplemented with combined treatments of the fusion zone. oil solution of vitamin A and methyluracil ointment. Usually one such procedure per day is added in a course of 5 days. Parents should not be frightened that at the very beginning of the course of conservative treatment there may be a slight swelling in the region of the labia of the daughter. This is a normal process, you should not cancel processing. Usually a side effect in the form of a small edema passes after 3-4 procedures.

If conservative treatment did not help or helped with a dubious result (it was not possible to completely eliminate the spikes with medicinal ointments), an operation is performed to remove the film from the child's labia. Here it is necessary to warn the parents - the number of gynecologists, "sadists" in Russia rolls over. According to the old, still Soviet practice, when they didn’t particularly stand on ceremony with synechiae, the doctor may suggest separating the labia manually, with a finger, actually simply breaking through the connecting film. Indeed, they did just that a few decades ago. But now it’s the 21st century, and therefore moms and dads shouldn’t expose their daughter to a painful procedure.

Agree only on a civilized operation to divide. It is performed under local anesthesia and not at all with your finger, but with instruments. Everything happens quickly, painlessly. After surgery is assigned "Ovestin" course for 7-10 days and then «Contractubex» to prevent relapse.

Even if everything is done correctly the probability of re-fusion remains quite high. According to available statistics, it is about 25-30%.

Not so long ago it was believed that synechia is necessarily a consequence of violation of the rules of hygiene.

Today, medicine has ceased to consider the hygienic factor as the main factor in the prevention of this intimate ailment. However, the hygiene is not completely devalued. Recommendations for the prevention of synechiae are useful to those who have had the disease to prevent recurrence, and those who do not want to admit the primary case:

• Allergenic foods should be avoided. If a girl has a tendency to an allergic reaction, this risk factor should be kept to a minimum.
• Care must be given child of the first year of life medicines. Inadequate reaction to them, side effects of drugs are dangerous, in terms of the development of skin problems, including in the area of ​​the external genital organs.
• To minimize the risks of bacterial infections of the urinary organs, which also lead to the development of adhesions, the girl should be flushed from birth. only under running waterand not in a basin or bath. In this case, the hand of an adult should move strictly in the direction from the pubis to the pope, and not vice versa.
• Use toilet soap (even baby) to wash the genitals of a little girl often not. It is quite enough to wash oneself with soapy water (not with a piece of soap!) Once a day, during the evening bathing. All flushing during the day is carried out with ordinary running water.
• When washing away, take care that soapy water did not fall on the delicate and vulnerable mucous membranesand also did not penetrate the vagina - this is a sure way to chemical irritation, which can become a “launching pad” for the formation of adhesions.

• All things that come into contact with the skin of tender intimate places of a little girl should be washed. only with hypoallergenic means which are specialized children. After washing, they should be additionally rinsed, and with increased individual sensitivity of the skin - even ironed.
• Clothes, panties, pajamas, bedding should be sewn from natural fabrics, without the use of synthetics and semi-synthetics. Bright panties that have become so under the influence of textile dyes, no need to buy. It is better to give preference to ordinary white fabric.
• After active games, swimming in a river or a pool, if the child is wet, you need to rinse the genitals with water and change your daughter in clean panties. The heat in the room, the heat in the bedroom affect the increase in sweating. Sex organs can also sweat. If the baby is sweating, it should be washed with plain water and changed into dry clothes.

About what synechia is and how to properly maintain the girl’s hygiene, see the following video.