Vulvovaginal Synechiae - An Overview

What Is Vulvovaginal Synechiae?

Vulvovaginal synechiae, also known as vaginal adhesion, are abnormal bands of tissue that can form inside the vagina. These bands of tissue cause adhesions or fusions between the walls of the vaginal canal. Vulvovaginal synechiae can lead to various symptoms and complications, including pain, discomfort, and difficulties with menstruation and sexual intercourse.

The main cause of this condition can differ or not be known exactly, but it may be the outcome of a few potential causes-

• Inflammation or Infection - Inflammatory conditions or infections affecting the vaginal area can lead to the formation of scar tissue, which may contribute to adhesions.

• Surgical Procedures - Certain gynecological surgeries, including episiotomy (surgical incision during childbirth), dilation and curettage (D&C), or other surgical procedures, can result in scarring and adhesions.

• Trauma and Injury - Any trauma or injury to the vaginal areas, whether from childbirth, accidents, or other sources. While the area is in the healing process, there is tissue formation called adhesions.

• Estrogen Deficiency - Changes in hormone levels, especially decreased estrogen, can contribute to thinning of the vaginal tissue and increase the risk of adhesions.

• Childhood Conditions - In some uncommon cases, this condition can occur in childhood due to a condition like lichen sclerosis, which is a chronic skin condition affecting the genitals and anal areas.

• Radiation Therapy - Pelvic radiation therapy, often used in cancer treatment, can cause changes in the vaginal tissues leading to the formation of adhesions.

It is important to note that the specific cause can vary among individuals, and sometimes, the exact cause may be challenging to identify. If someone is experiencing symptoms suggestive of vulvovaginal synechia, seeking medical attention for a thorough evaluation and proper diagnosis is essential for appropriate management and treatment.

What Are the Symptoms of the Vulvovaginal Synechiae?

The symptoms of vulvovaginal adhesions can vary depending upon the extent and location of adhesions. Common symptoms may include:

• Pain or Discomfort - Pain in the vaginal area, especially during the activities such as sexual intercourse or insertion of tampons, can be a common symptom.

• Menstrual Irregularities - Adhesions may affect the normal flow of menstrual blood, leading to irregular periods or difficulty with menstrual hygiene.

• Recurrent Infections - Adhesions can contribute to an increased risk of infection, such as fungal or bacterial infections, due to changes in the vaginal environment.

• Urinary Symptoms - In some cases, adhesion to the urethra may cause urinary symptoms such as difficulty urinating or increased frequency.

• Vaginal Dryness or Itching - Changes in the vaginal tissues may result in dryness and itching.

• Dyspareunia - Dyspareunia (painful sexual intercourse) is a common symptom associated with vulvovaginal synechiae.

What Is the Diagnosis of Vulvovaginal Synechiae?

Diagnosing the condition involves a mixed approach with proper information on medical history, physical examination, and sometimes additional diagnostic procedures.

1. Medical History - The healthcare provider will gather all information about the individual's medical history, including any symptoms, previous gynecological procedures, or conditions that may be relevant to the development of vulvovaginal adhesion.

2. Physical Examination - A pelvic examination is usually performed to assess the extent of adhesions and identify any associated symptoms. The healthcare provider will visually inspect the vaginal area.

3. Speculum Examination - A speculum (a device used by doctors to examine the hollow cavities like vaginal opening, anus, nostrils, or ears) may be gently inserted into the vagina to allow a closer examination of vaginal walls and to visualize any adhesions.

4. Biopsy or Culture - A biopsy or culture is performed to detect or exclude infections and other associated conditions contributing to the adhesions.

5. Imaging Studies - While not always necessary, imaging studies such as ultrasound (USG) or magnetic resonance imaging (MRI) may be done to get a better picture of the pelvic structures and rule out other potential causes.

It is important for individuals who experience the symptoms suggestive of vulvovaginal synechiae to seek medical attention. A healthcare professional, typically a gynecologist or woman's healthcare specialist, can diagnose accurately and recommend an appropriate treatment plan.

What Is the Treatment for Vaginal Adhesions?

The treatment for vaginal adhesions depends on the type and level of the infections, the root causes, and the individual's symptoms. Medical intervention is typically necessary, but home management strategies can complement professional care.

Medical Treatment:

• Topical Estrogen Therapy - If estrogen deficiency is a contributing factor, topical estrogen creams or suppositories may be prescribed to improve the health of the vaginal tissues and reduce adhesions.

• Gentle Separation Procedures - Healthcare professionals may perform gentle procedures to separate the adhesions carefully. This could involve using lubricant to perform minor procedures to release the fused tissue.

• Dilation Therapy - Gradual dilation using medical devices may be recommended to stretch and separate the adhesions over time. This is often done under medical supervision.

• Surgical Intervention - In extremely complicated cases, surgical procedures are considered to address extensive adhesions and restore normal anatomy. However, surgery is mostly done in cases that do not respond to more medicinal treatment measures.

What Are the Home Management Strategies?

• Warm Baths - Taking warm baths can help soothe discomfort and promote relaxation. Avoid using harsh soaps or bath products.

• Hydration and Lubrication - Staying hydrated and using water-based lubricants during sexual intercourse can reduce friction and minimize pain and discomfort.

• Cotton Undergarments - Choosing breathable cotton underwear promotes good ventilation and reduces moisture in the genital area.

• Avoid Irritants - Avoid harsh soaps, douches, or other irritants in the genital area. Opt for milder fragrance-free products.

• Pain Management - Over-the-counter pain medications or topical anesthetics may help manage pain. Consult with a healthcare provider for appropriate recommendations.

Home management strategies can be supportive, but they should be discussed thoroughly with a healthcare physician to ensure they align with the overall treatment approach and individual needs.

Conclusion

Vulvovaginal adhesions can have an impact on day-to-day normal life due to the discomfort and the pain. Turning for medical help promptly is essential for addressing the problems associated with it, which helps improve the symptoms and prevent complications. Individuals experiencing symptoms should seek prompt medical attention for timely treatment and management.