Acute or chronic lower urinary tract symptoms (LUTS) may be secondary to labial fusion in menopause. Early detection and treatment may help prevent progression of the condition. A 61-year-old, nulligravida, postmenopausal woman without sexual experience presented with partial labial fusion accompanying urinary tract infection and urinary retention. There was no follow up and five years later, when a transurethral catheterization failed during surgery for head and neck cancer, complete labial fusion and involuntary urine loss were observed in the patient. Uniquely, she had a sequence of different micturition symptoms over time. Surgical separation of the labial fusion, followed by use of topical estrogen, successfully restored the anatomy and voiding function in the postoperative two-year follow-up period. This case reminds us to examine postmenopausal patients with LUTS early, to review associated risk factors, and to treat these patients with multimodal strategies. Surgery in conjunction with topical treatment could be effective in elderly patients with labial fusion.