Labial Adhesions Treatment & Management
- Author: Kenneth G Nepple, MD; Chief Editor: Andrea L Zuckerman, MD more...
Medical Care
Labial adhesions can often be managed with periodic observation, and spontaneous resolution has been reported in as many as 80% within 1 year.[7] If treatment is necessary based on symptoms or parental request, estrogen cream is indicated. It is directly applied to the labia minora can be used twice daily for 2-4 weeks (see Medication).
A literature review performed in 2007 reported that the success rate of topical estrogen intervention in girls with labial adhesions is typically about 90%, with published success in case series reports ranging from 46.7-100%.[8] The use of steroid betamethasone 0.05% cream has also been described, with a reported success rate of 68%.[9] However, a recent single-institution, retrospective series found success rates of only 15% with topical estrogen, 16% with topical betamethasone, and 29% with combination therapy and no statistically significant differences between treatments.[10]
Parental use of the pull-down maneuver may also facilitate gentle takedown of adhesions (see Physical). Once the labia separate, apply an emollient (eg, A&D ointment, Balmex, Aquaphor) or antibiotic ointment 3-5 times a day for several months to allow complete healing and prevention of recurrence.
Surgical Care
If medical care does not result in separation of the labia minora, manual or surgical separation may be considered. Other reasons to consider intervention include severe fibrous dense adhesions or rare cases with urinary retention.
Depending on the maturity of the child and the expectations of the parents, surgical separation can be performed in a physician's office using a lidocaine and prilocaine (EMLA) cream as a topical anesthetic. Blunt separation of the labia is then performed using a lubricated probe or hemostat. Anesthetic sedation prior to the procedure can be used in select cases.
Alternatively, labial adhesions can be taken down in the operating room under general anesthesia. The adhesions separate very easily but are painful in the office without any anesthesia. Suture oversewing of the adhesions is typically not required.
The decision between the office and the operating room setting is based on the density of the adhesions, patient maturity, and the patient's ability to tolerate an in-office procedure. Most young patients who require manual separation for failure of estrogen cream treatment tolerate the procedure best in the operating room. The procedure is short and usually just requires gentle traction by the surgeon once anesthesia has been given. Postoperatively, an emollient needs to be placed on the separated labia minorum several times each day for 3-4 months by the patient or parent to prevent recurrence.
Consultations
Referral to a pediatric urologist or gynecologist can be made by providers uncomfortable with treating labial adhesions and in cases resistant to medical management.
Diet
Diet is not associated with labial adhesion formation.
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