Open Journal of Obstetrics and Gynecology, 2014, 4, 822-825 Published Online October 2014 in SciRes. http://www.scirp.org/journal/ojog http://dx.doi.org/10.4236/ojog.2014.414114 How to cite this paper: James, R., Sammarco, A., Sheyn, D. and Mahajan, S. (2014) Severe Labial Agglutination Release in a Postmenopausal Woman. Open Journal of Obstetrics and Gynecology, 4, 822-825. http://dx.doi.org/10.4236/ojog.2014.414114 Severe Labial Agglutination Release in a Postmenopausal Woman Rebecca James, Anne Sammarco, David Sheyn, Sangeeta Mahajan Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Cleveland, USA Email: rebecca.james@uhhospitals.org Received 3 July 2014; revised 3 August 2014; accepted 1 September 2014 Copyright © 2014 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Labial agglutination occurs when the labia minora have become fused in the midline through ei- ther filmy or dense adhesions, forming a raphe. This condition is typically seen in pre-pubertal girls; however, there have been cases reported in the literature of labial agglutination in postme- nopausal and reproductive aged women. Labial agglutination has been associated with local irri- tation and inflammation in the setting of a hypoestrogenic state. Topical treatment is usually recommended prior to manual separation. However, some postmenopausal women have been re- fractory to conservative management, and surgery may then be required. We present a case of a 79-year-old Caucasian gravida 3 para 3 who was referred for treatment refractory labial aggluti- nation for 3 years. The patient’s complaints included a small trickle escaping from the introitus during urination and the sensation of little urinary control. The patient underwent an exam under anesthesia. Gentle blunt dissection with a lacrimal dilator easily separated the labia minora down the visible midline fusion line (raphe). Bimanual exam then revealed a 12-week-sized enlarged uterus confirmed on ultrasound to be an 8 × 8 × 7 cm irregular mass concerning for uterine cancer. Proceeding to an operative release of severe labial agglutination can relieve patient discomfort and frustration when estradiol therapy has failed. In addition to alleviating symptoms, releasing labial agglutination can also provide the gynecologist access to critical screening procedures such as cervical cytology or a bimanual exam, all of which could lead to a diagnosis or pre-cancerous or cancerous lesions. Keywords Labial Agglutination, Hypoestrogenic State 1. Introduction Labial agglutination occurs when the labia minora have fused by formation of adhesions at the midline, which