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Labial Fusion Causing Recurrent Cyst Formation and a Novel Approach to Surgical Management

Selco, Mitchell M. BA, CPO, USN*; Doss, Roderick H. DO, LCDR, MC, USN; Gruber, Daniel D. MD, LtCol, MC, USAF; Shippey, Stuart H. MD, CDR, MC, USN§

Female Pelvic Medicine & Reconstructive Surgery: September/October 2013 - Volume 19 - Issue 5 - p 312–314
doi: 10.1097/SPV.0b013e318292460e
Case Reports

Background Labial fusion may occur as a result of lichen sclerosus, lichen planus, genital mutilation, obstetric laceration, and atrophic vaginitis. Koebner phenomenon, or reformation of scar tissue over the clitoris after trauma to the involved tissue, may confound attempts at surgical management.

Case A 22-year-old nulligravid patient presented with labia minora fusion that had been present since childhood. Her most bothersome symptoms were the recurrence of periclitoral pseudocysts with pain and discharge after spontaneous or needle drainage. Her symptoms and examination findings persisted despite a prolonged course of topical clobetasol, and she desired surgical intervention. A silastic vessel loop was placed through the tract between her clitoris and fused overlying labia. The ends of the vessel loop were brought together and tied in a fashion similar to cutting setons used to manage complex anal fistulae. Over the subsequent weeks, additional ties were used to sequentially tighten the loop and gradually divide the fused labia, ultimately exposing the patient’s normal clitoris, which was uninjured by the procedure. Topical clobetasol was used throughout the process to prevent reagglutination of the labia.

Conclusions Our experience suggests that adaptation of a cutting seton may be used effectively in the surgical management of labial fusion to allow for gradual division of the skin bridge while minimizing the risk of recurrence of agglutination.

From the *College of Osteopathic Medicine, Touro University, Vallejo, CA; †Naval Hospital Beaufort, Beaufort, SC; ‡Walter Reed National Military Medical Center, Bethesda, MD; and §Naval Medical Center, Portsmouth, VA.

Reprints: Stuart H. Shippey, MD, CDR, MC, USN, Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, VA 23708. E-mail: shshippey@yahoo.com.

The authors have declared they have no conflicts of interest.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

Several authors are military service members. This work was prepared as part of their official duties. Title 17 USC 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 USC 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

© 2013 by Lippincott Williams & Wilkins