On physical examination, the vulva and labia minora of these girls are seen to be completely adherent, so that there is no way to visualize the internal vagina. In the case of minor adhesions, a thin, translucent membrane can be seen, while in other cases the adhesions are more dense and fibrous. As for the clitoris, it is usually buried so that it cannot be seen or felt. If examined by ultrasound scanning, the bladder wall can be seen to thicken, indicating that some people may be affected by urinary tract obstruction. However, a cystourethrography of the bladder during urination does not indicate that there is vesicoureteral reflux. Labial fusion is usually asymptomatic, although sometimes it can become infected and inflamed. This can lead to incorrect diagnosis of a urinary tract infection. This is because the urine comes out and collects in the vagina, so that the urine sample taken is contaminated, resulting in a judgment of infection. In a few cases, this may even lead to an incorrect diagnosis of vaginal atresia, causing a great psychological burden on the child’s parents. Physical examination focuses on the vulva, observing vulvar development, skin color, clitoris size, and whether there is any deformity. Important auxiliary examination for vulvar developmental deformities, to carry out chromosome karyotype analysis, sex hormones and 17 a ketone steroid determination. In the case of concomitant lesions of the vulva, biopsy should be performed to clarify the etiology.