Surgical Management of Near Complete Labia Majora Fusion Without Hymenal Disruption

A 25-year-old asymptomatic nulliparous female presented with near-total midline fusion of the labia majora detected during routine physical examination. The patient reported a history of perineal trauma from a fall 19 years before, resulting in minor genital bleeding that resolved spontaneously without medical intervention.

Initial outpatient management with topical estriol ointment for 2 weeks failed to achieve adhesiolysis. The gynecological evaluation confirmed complete fibrous adhesion extending from the prepuce clitoridis to the posterior fourchette (Fig. 1). In accordance with the patient's cultural requirement for hymenal preservation, hysteroscopic-guided surgical separation was performed.

Department of Gynecology, The Second People's Hospital of Guiyang.

Intraoperative inspection verified intact hymenal integrity and patent urethral meatus, with no subadhesion tissue identified (see supplemental video). The procedure successfully restored normal vulvovaginal anatomy (Fig. 2) without damage to the hymen, and this was important to the patient. Postoperative recovery proceeded without complications, with no adhesion recurrence observed at an 18-month follow-up (Fig. 3).

Labial adhesions may be congenital or acquired, predominantly occurring in prepubertal females [1]. Although labia minora adhesions have been well documented with an incidence rate of 1.8% to 3.5% [2] and standardized treatment protocols have been proposed [3], labia majora fusion remains a rare clinical entity. Potential complications include dyspareunia, urinary retention, and recurrent infections [4]. The 19-year latency period from traumatic injury to therapeutic intervention represents the longest documented persistence of labia majora adhesion searching PubMed. Hysteroscopic visualization facilitated targeted anatomical dissection through natural orifices, achieving the dual objectives of complete adhesiolysis and hymenal preservation essential for cultural compliance, a distinct advantage over conventional probe-guided approaches [5]. This technique's capacity to resolve extensive fibrous fusion without damage to the hymen or deeper vaginal structures suggests that endoscopic methods may address both anatomical and sociocultural needs in selected patients, pending validation through multicenter longitudinal studies.