Labial
Lala Klingerman
Labial consonants are consonants in which one or both lips are the active articulator. The two common labial articulations are bilabials, articulated using both lips, and labiodentals, articulated with the lower lip against the upper teeth, both of which are present in English. A third labial articulation is dentolabials, articulated with the upper lip against the lower teeth (the reverse of labiodental), normally only found in pathological speech. Generally precluded are linguolabials, in which the tip of the tongue contacts the posterior side of the upper lip, making them coronals, though sometimes, they behave as labial consonants.[clarification needed]
The most common distribution between bilabials and labiodentals is the English one, in which the nasal and the stops, [m], [p], and [b], are bilabial and the fricatives, [f], and [v], are labiodental. The voiceless bilabial fricative, voiced bilabial fricative, and the bilabial approximant do not exist as the primary realizations of any sounds in English, but they occur in many languages. For example, the Spanish consonant written b or v is pronounced, between vowels, as a voiced bilabial approximant.
Lip rounding, or labialization, is a common approximant-like co-articulatory feature. English /w/ is a voiced labialized velar approximant, which is far more common than the purely labial approximant [β̞]. In the languages of the Caucasus, labialized dorsals like /kʷ/ and /qʷ/ are very common.
Very few languages, however, make a distinction purely between bilabials and labiodentals, making "labial" usually a sufficient specification of a language's phonemes. One exception is Ewe, which has both kinds of fricatives, but the labiodentals are produced with greater articulatory force.
Many of these languages are transcribed with /w/ and with labialized consonants. However, it is not always clear to what extent the lips are involved in such sounds. In the Iroquoian languages, for example, /w/ involved little apparent rounding of the lips. See the Tillamook language for an example of a language with "rounded" consonants and vowels that do not have any actual labialization. All of these languages have seen labials introduced under the influence of English.
Treatment of labial adhesions is typically conservative. [4] Labial adhesions can often be managed with periodic observation; spontaneous resolution may occur and commonly occurs during puberty. Further management considerations are as follows:
Labial adhesions are fibrous adhesions between the labia minora. Low estrogen levels have been thought to play a causative role in their formation, and the protective effect of maternal estrogen makes labial adhesions uncommon during the newborn period. [5] However, a 2007 study found no statistically significant difference in serum estradiol levels between infants with labial adhesions and control subjects. [6]
Labial adhesions may also be caused by vaginal inflammation, local irritation, or tissue trauma. They have been reported to result from childhood sexual abuse and may be associated with lacerations or hematoma. [7, 8]
A prospective study of more than 1900 girls assessed through a pediatric outpatient clinic reported a 1.8% incidence of labial adhesions, whereas a review of more than 9000 female infants found no cases of neonatal labial adhesions. [5] The incidence of labial adhesions worldwide is unknown but presumably is similar to the US incidence.
Labial adhesions are, by definition, a disorder of females and occur most often in infants and girls aged 3 months to 6 years, with a peak incidence around the age of 13-23 months. [5] They have not been reported in the newborn period. If left untreated, labial adhesions usually spontaneously resolve at puberty as a consequence of increased estrogen levels. They also occur in older women, albeit rarely. [9, 10]
Labial adhesions are generally asymptomatic and are not a common cause of urologic or gynecologic morbidity. In rare cases, they can cause urinary outflow deflection or obstruction, leading to vaginal reflux of urine and subsequent vaginal leaking when the child stands after voiding.
Recurrence of labial adhesions is common and has been reported in as many as 11.6-14% of cases [11, 12] ; however, the true recurrence rate may be higher with longer follow-up. [13] A study by Wejde et al suggested that manual separation may yield better overall final outcomes than topical estrogen. [14] One report noted a decreased recurrence rate when topical estrogen was used after manual reduction of labial adhesions. [12] It is important to counsel the parents to use an emollient several times a day for several months.
Adverse systemic effects of estrogen cream are rare and reversible once medication is discontinued. Estrogen cream application often causes temporary hyperpigmentation of the skin in the area of application; patients should be reassured that this hyperpigmentation normally fades after therapy ends. Another reported side effect is breast tenderness or enlargement, [11] which resolves when use of the cream is stopped.
To decrease the risk that labial adhesions will recur after having been opened either by use of estrogen cream or by manual separation, an emollient should be used several times a day for several months.
Kenneth G Nepple, MD Assistant Professor, Department of Urology, University of Iowa Hospitals and Clinics
Kenneth G Nepple, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association
Disclosure: Nothing to disclose.
Christopher S Cooper, MD, FACS, FAAP Professor with Tenure and Vice Chair, Department of Urology, Tyrone D Artz Chair in Urology, Professor, Department of Pediatrics, Director of Pediatric Urology, Senior Associate Dean for Medical Education and Research Facility, Children's Hospital of Iowa, University of Iowa, Roy J and Lucille A Carver College of Medicine
Christopher S Cooper, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, International Children's Continence Society, Phi Beta Kappa, Societies for Pediatric Urology, Society for Fetal Urology
Disclosure: Nothing to disclose.
Andrea L Zuckerman, MD Associate Professor of Obstetrics/Gynecology, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center
Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.
Labial adhesion is the fusion of the labia minora or majora, and it is mostly located near the clitoris. It also may be known as synechia vulvae or labial agglutination. The exact cause for labial adhesions remains unknown. However, it is believed that a state of low estrogen may be a contributing cause. Therefore, these patients are typically managed with estrogen cream when symptomatic.This activity reviews the pathophysiology of labial adhesions and highlights the role of the interprofessional team in its management.
Objectives:
- Review the cause of labial adhesions.Describe the presentation of labial adhesions.Summarize the treatment options for labial adhesions.Outline the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by labial adhesions.
Labial adhesion is the fusion of the labia minora or majora, and it is mostly located near the clitoris. It also may be known as synechia vulvae or labial agglutination. The exact cause for labial adhesions remains unknown. However, it is believed that a state of low estrogen may be a contributing cause. Therefore, these patients are typically managed with estrogen cream when symptomatic.[1][2][3]
This entity is mostly an incidental finding since the majority of the patients have no symptoms. As the name implies, labial adhesion is a fusion of the labia minora or majora. The exact cause of labial fusion remains unknown. However, it is believed to occur in a low estrogen state. It is rare in the reproductive age group due to the sufficient levels of estrogen found in this population.[4][5][6]
For those who do develop labial adhesions during the reproductive age, there is usually a history of some sort of genital trauma or irritation to the genitalia. Examples of genital trauma may include childbirth, sexual abuse, and genitourinary surgery. Management for these patients tends to consist of lysis of the adhesion as well as applying topical estrogen cream. There have been cases of labial adhesion in the postpartum period. It is believed that a possibility may be due to breastfeeding along with the irritation and trauma that occurs during vaginal delivery. The reasoning behind breastfeeding as a cause is that when a mother breastfeeds her baby, prolactin is increased prolactin, leading to a decrease in estrogen and resulting in a hypoestrogenic state. Management remains the same. For preventive measures, it is recommended for minimization of vulvar irritation accompanied by adequate hygiene to the perineal area. Another recommendation may be for the resumption of sexual activity.
Labial adhesions also may be found during another low estrogen stage, the postmenopausal stage. In this stage, due to the low estrogen, the genital area is susceptible to irritation and inflammation, which may lead to adhesion. In this age group, the risk of fusion increases when the patient has a history of diabetes mellitus, lichen sclerosis, or diminished sex.
The condition is believed to be due to inflammation of the labia in a low-estrogen environment. It is thought to occur in a hypoestrogenic state due to it being very uncommon in the newborn period when there is maternal estrogen influence as well as during the reproductive period when there are adequate estrogen levels. The inflammation can be due to infection as well as to poor hygiene, including stool contamination.
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