Surgical Management of Total Labial Agglutination in a Postmenarchal Adolescent

INTRODUCTION: This video presents the surgical restoration of vaginal anatomy in a rare case of total labial agglutination in a postmenarchal adolescent without evidence of hypoestrogenic status or trauma. A 14-year-old cisgender female presents with left labial pain and swelling. Menarche was at age 10. She has regular menses, has never been sexually active, and has no history of pelvic trauma. She has never had a pelvic exam. On exam, Tanner stage is appropriate, and there are no signs of a hypoestrogenic state; however, the labia minora are completely fused, obscuring the vestibule. There appears to be a pinpoint opening at the inferior midline of the fused labia. The patient endorses mild tenderness of the left labial fold upon palpation. Anus and perineum are normal. Pelvic ultrasound shows a normal uterus and adnexa. On translabial views, a 1.6-cm anechoic, avascular cystic structure is seen in the vaginal wall. OBJECTIVE: Our objectives are to review the presentation, evaluation, surgical management, and follow-up of a postmenarchal adolescent with total labial agglutination. METHODS: The video shows the surgical management of the patient. Vaginal anatomy is restored via lysis of labial adhesions; drainage and marsupialization of a left-sided vulvar abscess are also performed. RESULTS: A small area of re-agglutination is noted on exam 1 week postoperatively and excised sharply under local anesthesia in the office. A 5-week follow-up exam confirms no further re-agglutination. The patient is advised to continue long-term maintenance with betamethasone 0.05% ointment and vaginal dilators. CONCLUSIONS: This video describes the case and demonstrates the surgical management of a rare instance of labial agglutination in a postmenarchal adolescent without evidence of hypoestrogenism or physical trauma. Vaginal anatomy was successfully restored via lysis of the labial adhesions, as shown in the video.