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Summary:
Twenty girls with labial fusion that covered at least 50% of the vaginal opening were treated with a topical estrogen cream. The cream was precisely applied to the fused area twice a day until the adhesions were totally lysed. After separation of the adhesions, a petroleum ointment (Vaseline®) was applied twice a day to the labia minora for at least 1 month. The introital area was carefully rinsed twice each day before application of either the estrogen cream or the petroleum ointment. The mean age of the studied population was 13.2 months (range, 2 to 38 months). The mean duration of estrogen treatment was 2.4 months (range, 1 to 3.5 months). All patients were successfully treated. Five patients developed vulval pigmentation, which lasted for a mean of 1.5 months. One patient developed breast enlargement, which lasted for 1 month. The mean duration of follow-up was 3.1 months, and there was no recurrence of labial fusion during the period of follow-up. We conclude that treatment of labial fusion with topical estrogen therapy is safe and effective. Clin Pediatr. 2005;44:245-247
Introduction
Labial fusion refers to partial or complete adherence of the labia minora.1 Other names for this condition are vulvae fusion, atresia of the vulva, synechia of the vulva, occlusion of the vestibule, atresia vulvae superficialis, adhesion of the labia minora, and agglutination of the labia minora.2,3 Labial fusion predisposes to asymptomatic bacteriuria and urinary tract infection.4-6 Rarely, the labial fusion is so nearly complete as to cause urinary outflow obstruction with resultant bladder distention or hydronephrosis.7,8 Parental anxiety about the problem can be considerable. Topical estrogen therapy is the treatment of choice.1,9,10 We report our experience with the use of a topical estrogen cream in the treatment of 20 patients whose labial fusion covered at least 50% of the vaginal opening.
Methods
Girls with labial fusion who were assessed at an ambulatory care clinic in Calgary, Alberta, Canada, between February 2002 and May 2004 were recruited into the study. Patients were included in the study if the fusion covered at least 50% of the vaginal opening and were excluded if they had been treated in the past for this condition. Parents were advised to apply an estrogen cream (Premarin® cream, Wyeth-Ayerst) precisely to the...