Vulvar fusion as a late complication of Genitourinary Syndrome of Menopause

Abstract

Objective: Genitourinary syndrome of menopause (GSM) comprises of the vulvovaginal, bladder, and urethral changes associated with decreased estrogen levels. These changes include genital dryness, recurrent urinary tract infections, and atrophic changes to the labia, introitus, vagina and urethra. Although these changes are common in menopausal women, they may occur at any age if the patient presents a decrease in estrogen levels. An uncommon manifestation of genitourinary syndrome of menopause is vulvar fusion (also known as labial fusion, labial agglutination, labial adhesion and vulvar synechiae) which has been defined as the total or partial adherence of the labia minora and/or majora. Two of the main etiologic factors for vulvar fusion include low estrogen levels and cessation of sexual activity. This pathology can be congenital or acquired, and although common in the pediatric population, few cases have been reported in post-menopausal women. Design: Discussion of 3 cases of labial agglutination in women of marked advanced age Results: This study presents 3 cases of labial agglutination in women of marked advanced age, who presented with complaints of urinary incontinence and dribbling, urinary retention, difficulty voiding, dysuria, and urodynia due to urethral outlet obstruction by the labia minora and majora, urocolpos, bilateral hydronephrosis and bilateral megaloureters.