Labial fusion in prepubescent girls: a marker for sexual abuse?

Review of more than 500 medical records of patients referred for sexual abuse evaluations revealed 10 cases of labial fusion. Patients ranged in age from 2 months to 5 years, and the duration of the fusion ranged from 2 weeks to 2 1/2 years. No child had vulvovaginitis, dermatitis, or known genital trauma (for instance, straddle injury). Urinary tract problems were present in three patients. History and/or physical findings were consistent with sexual abuse in six of the 10 patients. Anal findings were grossly abnormal and consistent with anal penetration in all patients with a positive finding on examination. Therapy with conjugated estrogen cream was instituted in nine patients, with resolution of symptoms occurring in six. The exact cause of labial fusion is unclear. Fusion secondary to fecal soiling may occur in the young infant. Older girls may develop fusion after trauma such as that associated with sexual abuse, particularly vulvar coitus.