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Article
March 1989

Picture of the Month

Author Affiliations

Contributed from the Department of Pediatrics, Maricopa Medical Center, Phoenix.

Am J Dis Child. 1989;143(3):381-382. doi:10.1001/archpedi.1989.02150150143035
Abstract

The statements listed below are best associated with which of the above figures:

(a) This disorder may be successfully treated with estrogen cream.

(b) Primary amenorrhea in adolescence is a presenting symptom.

(c) Patients with this condition should be reported to the public health department and a child protective agency.

Denouement and Discussion  (a) Labial fusion is the partial or complete adherence of the labia minora (Fig 2). It most likely develops secondary to denudation of the upper squamous epithelial layer of the labial mucosa with formation of a thin connective-tissue bridge. Adhesion of the labia minora occurs in women with low estrogen levels, prepubescent girls, and postmenopausal women. Inflammatory conditions such as vulvitis, diaper dermatitis, and trauma may be important predisposing factors. Labial adhesions can be separated manually or with the use of an estrogen cream.(b) Normally the hymen is a membranous diaphragm with a central

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