Abstract
Labial adhesions, also known as labial agglutination, are a common finding in prepubertal
adolescents. They are defined as fusion of the labia minora in the midline or are
termed vulvar adhesions when they occur below the labia minora (inner labia). Patients
are often asymptomatic but might present with genitourinary complaints. The decision
for treatment is based on symptoms. The mainstay of treatment in asymptomatic patients
is conservative, with careful attention to vulvar hygiene and reassurance to parents.
In symptomatic patients, topical treatment with estrogen and/or steroid cream is often
curative. Less often, corrective surgery is necessary. Recurrence is common until
a patient goes through puberty. These recommendations are intended for pediatric and
gynecologic health care providers who care for pediatric and adolescent girls to facilitate
diagnosis and treatment.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Labial fusion in children: a presenting feature of genital Lichen Sclerosis?.Pediatr Dermatol. 1999; 16: 388
- Success of treatment modalities for labial fusion: a retrospective evaluation of topical and surgical treatments.J Pediatr Adolesc Gynecol. 2009; 22: 247
- Labial adhesions in a girl with isolated thelarche: the importance of estrogenization.J Pediatr Adolesc Gynecol. 2003; 16: 31
- How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: estrogen only, betamethasone only, and combination estrogen and betamethasone.J Pediatr Adolesc Gynecol. 2011; 24: 389
- Microbiological aspects of vulvovaginitis in prepubertal girls.Eur J Pediatr. 2012; 171: 1203
- A case- control study of anatomic changes resulting from sexual abuse.Am J Obstet Gynecol. 2000; 182: 820
- Do hygienic factors affect labial fusion recurrence? A search for possible related etiologic factors.J Pediatr Surg. 1913; 2012: 47
- Labial agglutination in a teenager.J Pediatr Adolesc Gynecol. 2003; 16: 61
- Diagnosis and management of vulvar skin disorders.American College of Obstetricians and Gynecologists, Washington (DC)2008 (11 (ACOG practice bulletin; no. 93)
- Pro-conservative management for asymptomatic labial adhesions in the prepubertal child.J Pediatr Adolesc Gynecol. 2000; 13: 183
- Prepubertal vulvovaginopathies.Obstet Gynecol Clin North Am. 1992; 19: 39
- The incidence of labial fusion in children.J Paediatr Child Health. 2008; 29: 235
- Pediatric vulvovaginal disorders: a diagnostic approach and review of the literature.J Obstet Gynaecol Can. 2009; 31: 850
- Labial adhesions in childhood.J Pediatr Health Care. 1996; 10: 26
- Topical estrogen therapy for labial adhesions in children.Br J Obstet Gynaecol. 1957; 82: 424
- The response of phimosis to local steroid application.Pediatr Surg Int. 1993; 8: 329
- Treatment of prepubertal girls with labial adhesions.J Pediatr Adolesc Gynecol. 1999; 12: 67
- Prepubertal labial adhesions: evaluation of a referral population.Am J Obstet Gynecol. 2002; 187: 327
- Use of intranasal midazolam for manual separation of labial adhesions in the office.J Pediatr Adolesc Gynecol. 2013; 26: 195
- The surgical treatment of labial adhesions in pre-pubertal girls.J Pediatr Adolesc Gynecol. 2003; 16: 21
- Topical estrogen therapy in labial adhesions in children: therapeutic or prophylactic?.J Pediatr Adolesc Gynecol. 2007; 20: 241
- Vulvar fusion.J Urol. 1949; 62: 75
- Office pediatric urologic procedures from a parental perspective.Urology. 2000; 55: 272
- Estrogen treatment success in recurrent and persistent labial agglutination.J Pediatr Adolesc Gynecol. 2006; 19: 381
Article info
Publication history
Published online: April 23, 2015
Footnotes
The authors indicate no conflicts of interest.
This Clinical Recommendation was prepared by Janice Bacon, MD, and Mary Romano, MD, MPH, with expert review from Elisabeth Quint, MD. This document has been reviewed by the Education Committee and approved by the Board of the North American Society of Pediatric and Adolescent Gynecology. This Clinical Recommendation reflects the currently available best evidence for practice at the time of publication. This recommendation is designed to aid practitioners is making decisions about appropriate care, but should not be construed as dictating an exclusive course of management. Variations in practice might be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.
Identification
Copyright
© 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
