Intrauterine synechiae. hysteroresectoscopy

Causes of synechiae

1. Genitourinary infections - vulvovaginitis, vulvitis, etc. Infection is possible in the maternity hospital or at home, when swimming in stagnant natural bodies of water.
2. Violation of intimate hygiene rules. Both a lack of hygiene and its excess are harmful.
3. Allergy in a child. A reaction can occur to food (from the diet of a girl or a nursing mother), components of care products, washing powder, etc.
4. Difficulties during pregnancy - intrauterine infections, severe toxicosis. If a mother had difficulties during pregnancy, her daughter increases the risk of developing synechiae.
5. Genetics. The tendency to fusion of soft tissues can be transmitted from mother to daughters.
6. Wearing tight synthetic underwear, which creates all the conditions for inflammation.
7. Reduced estrogen levels. This is normal before puberty, but in some girls it causes synechiae.
8. Dysbacteriosis. Pathogenic intestinal flora can provoke adhesions. Source: Z.K. Batyrova, E.V. Uvarova, L.S. Namazova-Baranova, N.Kh. Latypova, A.E. Donnikov Fusion of the labia minora in girls during early childhood: tactics of a pediatric gynecologist // Issues of modern pediatrics, 2012, vol. 11, no. 2, pp. 118-121

Symptoms and signs of fusion of the labia majora and minora in a child

With complete adhesion:

• There are difficulties with urination. The child becomes very nervous when the urge arises, strains hard on the potty, cries, and refuses to go to the toilet.
• Stagnation of urine causes infections in the urethra, which are manifested by: rash;
• redness and peeling of the skin in the intimate area;
• secretions.

The mother can examine the girl herself. To do this, you need to separate the labia majora. With synechia, the small ones do not “come apart” and they are connected by a whitish-gray film, similar to a membrane. When trying to separate the labia minora, the child begins to cry - it hurts.

How to treat the disease?

If a girl has small (up to 5 mm) synechiae between the labia minora and labia majora, then this is not dangerous. The outflow of urine is not impaired, negative consequences are excluded. Therefore, in this case, you only need to show the child to a pediatric gynecologist once every six months. For synechia of the labia minora, conservative or surgical treatment may be prescribed. The doctor will give recommendations on proper hygiene and child care.

Conservative therapy is the use of ointments with estrogen in a course that is calculated individually (from 1 week to 2 months). As a result, the labia separate, and the ointment is gradually replaced with a baby cream recommended by the doctor.

If the case is advanced, surgery is needed. Synechiae are divided surgically under local anesthesia or general anesthesia. To prevent a relapse, they then make baths with herbs and use ointments.

Treatment

The therapeutic tactics for managing the patient greatly depend on the degree of development of the fusion, the body’s reaction, the causes of the anomaly and age. If the fusion is incomplete, then not dissection is required, but treatment with local hormonal drugs specially developed for such cases - the adhesion is treated with estrogen ointment. Treatment with hormonal ointment can only be done under the strict supervision of a doctor due to possible complications. The main one is early development, when a girl of 10 years or even younger develops secondary sexual characteristics (the mammary glands swell, body hair grows).

In later stages of the disease, the main treatment option is surgery on the fused tissues. The intervention is carried out using local anesthesia, which is administered using a special probe. Parents may remain with the child during the operation. Sometimes general anesthesia is used.

Fallopian tube adhesions or Asherman's syndrome (uterine pathology) require a more serious approach to treatment and mandatory surgery. To avoid the development of such serious pathologies, you should regularly visit a gynecologist. In addition to operations using an endoscope or hysteroscope, high-tech operations can be performed using water, a laser beam or electric current.

Rehabilitation after surgery

Adhesions are characterized by relapses, so no doctor can give a guarantee of a 100% cure. If you do not get rid of the causes of the disease, the pathology may develop again. A healthy lifestyle and moderate use of hygiene products will significantly reduce the risk of new accretion lesions.

As a rehabilitation agent, on the recommendation of a doctor, special ointments, gels and creams are used for 1.5-3 months after the main treatment. They are applied daily to the problem area to soften the tissue and prevent re-infection. These local products effectively moisturize mucous membranes and relieve irritation. It must be borne in mind that the disease has a tendency to relapse. Recurrence of adhesions is especially often diagnosed at the age of 6-9 years.

Prevention

Preventive measures are mandatory for all girls; they will avoid the fusion of individual parts and the organs themselves. For prevention it is necessary:

• maintain hygiene within reasonable limits - according to sanitary recommendations, but nothing more;
• after water procedures, blot the vulva with a clean cloth without rubbing;
• if the mucous membranes are dry, apply a moisturizer daily as recommended by your doctor;
• for hygiene, use only special soap without components that contribute to allergic reactions;
• do not use soapy baths for children;
• do not rub the girl’s skin with washcloths and sponges, especially in intimate places;
• give preference to loose-fitting clothes and underwear made from natural fabrics.

The girl should be washed after defecation with clean warm water using high-quality baby soap. If there is no such soap, then it is better to limit yourself to washing with plain water than to use low-quality soap or products for adults - they are too aggressive for the delicate skin of children. The washing movements should follow a line directed from the vagina to the anus. Reverse movements are harmful - they contribute to the spread of infection from the intestines to the reproductive system.

After bathing, examine the baby; if signs appear that are uncharacteristic of a healthy child, you should consult with your local pediatrician. Connective tissue bridges are visible even to a non-specialist. To prevent the disease, you need to get rid of all potential allergens, including diapers and other items that cause a rash, redness on the skin, allergic runny nose or sneezing.

Even the highest quality children's products from serious manufacturers and well-known brands can cause allergies - each body is individual. The color of the skin in the perineal area should not change; any excessive redness, pink stripes or spots are an alarming signal that requires taking measures to eliminate allergens. If the situation repeats, a mandatory consultation with a qualified doctor is necessary.

Gynecological diseases occur not only in women, but also in little girls. Synechiae of the labia minora, fallopian tubes and uterus require careful diagnosis and timely treatment so that the disease does not have a negative impact on health. Do not delay contacting a pediatric or adult gynecologist - this will allow treatment to be limited to minimally invasive intervention or drug therapy.

Prevention in girls

Important! All newborn girls under 2 years of age must be shown to a pediatric gynecologist in order to identify synechiae as early as possible and avoid surgery. This is especially true for girls with allergies who are at risk.

Synechia of minora and labia majora in girls is prone to multiple relapses even after surgical treatment. The problem goes away completely only after the child reaches puberty. However, the risk of relapse can be reduced by following the basic rules of prevention - hygiene and daily routine. Source: Gayle O. Fischer Vulval disease in pre-pubertal girls // Australasian Journal of Dermatology. 2001, 42, 225-236

Prevention recommendations:

• Change diapers in a timely manner and give them up as soon as possible.
• Pay maximum attention to hygiene - gently wash the girl twice a day with warm water. There is no need to use soap and other cosmetics, because they wash out the microflora and dry out the mucous membranes of the vagina.
• Contact your doctor if your child complains of difficulty urinating.
• Use any creams or ointments for the intimate area only after consulting a doctor.
• Don't get carried away with bubble baths. If the child loves them very much and does not want to give them up completely, you can add them at the very end of the bath.
• A girl's underwear should be made of 100% cotton because it allows the skin to breathe and ventilate well. Make sure that the underwear does not rub or press anywhere, as this can lead to inflammation.
• Regularly show the girl to a pediatric gynecologist, even from the age of an infant, in order to promptly notice not only synechiae, but also other pathologies. Many mothers believe that little girls do not need this, but the doctors’ recommendation is clear: start visiting a gynecologist from preschool age.
• In most cases, the causes of synechiae are incorrect and/or incompletely treated infectious and viral diseases. Therefore, it is necessary to show the child to the doctor in a timely manner and follow all his recommendations.
• It is better to wash children's clothes separately from adult clothes.
• In the third trimester, the expectant mother must actively fight late toxicosis - high blood pressure, protein in the urine, edema. Such symptoms complicate childbirth and lead to pathologies in infants.
• Buy toilet paper, cosmetics and detergents without fragrances or artificial colors.
• As a preventive measure, use ointments with estrogen, but only for those girls who have previously had clumping of the labia. The duration of treatment and dosage are determined only by the doctor.

Sources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846402/ S. Bussen, A. Eckert, U. Schmidt, and M. Sütterlin Comparison of Conservative and Surgical Therapy Concepts for Synechia of the Labia in Pregnancy -Pubertal Girls
2. Z.K. Batyrova, E.V. Uvarova, L.S. Namazova-Baranova, N.Kh. Latypova, A.E. Donnikov. Fusion of the labia minora in girls during early childhood: tactics of a pediatric gynecologist // Issues of modern pediatrics, 2012, vol. 11, no. 2, pp. 118-121.
3. Gayle O. Fischer. Vulval disease in pre-pubertal girls // Australasian Journal of Dermatology. 2001, 42, pp. 225-236.

What are these synechiae, what are their consequences?

Synechiae is the fusion of the mucous membranes of the left and right labia minora. There is a kind of strong gluing of the labia minora in the girl. As a result, the visualization of the anatomical structures of the genital fissure is closed. Namely the openings of the vagina and urethra.

Urine comes out of the urethra when you urinate. And when a closed cavity occurs as a result of fusion, difficulties arise when urinating. The girl is straining and experiencing discomfort. Urine can stagnate, and a closed cavity causes inflammation. The mucous membrane of the external genitalia becomes inflamed first, but then the inflammation can spread upward to the internal organs. This is the urethra, bladder, vagina. The child experiences changes in the urine in the form of an increase in leukocytes in the urine and the appearance of bacteria in the urine. The girl may experience discomfort in the form of burning and itching. The spread of the inflammatory process to internal organs can cause infection of the kidneys and internal genital organs. Long-term synechiae aggravate inflammation and complicate subsequent treatment, forming a rough and dense scar at the site of fusion.

Unfortunately, sometimes there are cases of late detection of fusions of the labia minora in girls. This is because complications due to synechiae can appear after a long period of time from the moment of formation of synechiae and their development is directly proportional to the size of the synechiae. And only when the child complains of discomfort, parents are forced to consult a doctor. If there are suspicions of synechia and problems with urination, changes in urine tests in a girl, you should contact a pediatric gynecologist, pediatrician and nephrologist. And if the doctor discovers the presence of synechiae, then, of course, the cause of the discomfort and changes in the urine were the synechiae. Depending on the size of the fusion, the gynecologist will select a treatment method.

How to treat synechiae?

If there is inflammation, then this is hygiene and local solutions and anti-inflammatory ointments. Means for maintaining a favorable microbial landscape. To choose the right treatment, the gynecologist will prescribe a flora culture and a gynecological smear. It is the pediatric gynecologist who will decide which method to treat synechiae. This means that the doctor, upon examination, will determine whether the use of ointments alone will be sufficient for the synechiae to soften and self-dilution to occur, or whether it is necessary to use surgical dilution of the synechiae. If synechiae is treated with ointments, it can take from several days to months. The procedure for diluting synechia surgically is practically painless and lasts no more than 15-30 seconds.