Spontaneous resolution of labial adhesions in pre-pubertal girls

Effect of topical estrogen cream compared with observation in prepubertal girls with labial adhesions

BACKGROUND

Topical estrogen treatment has been considered the first-line treatment of labial adhesions in prepubertal girls. However, the effect of topical estrogen cream is different according to studies, and no study compared estrogen cream to observation.

OBJECTIVE

This study aims to investigate the efficacy of topical estrogen cream treatment compared with observation in prepubertal girls with labial adhesions.

STUDY DESIGN

The medical records of prepubertal girls diagnosed with labial adhesions from April 2005 to June 2019 were retrospectively analyzed. Baseline characteristics such as age at diagnosis and initial symptoms were collected. The primary outcome was the resolution of labial adhesion. Secondary outcomes were recurrence and side effects.

RESULTS

A total of 114 patients were enrolled and divided into two groups, topical estrogen cream (n = 94), and observation (n = 20). Girls who were treated with estrogen cream had older age (24.6 ± 19.0 vs. 16.7 ± 15.3 months, p = 0.037) and higher resolution rate than the observation group (100.0% vs. 85.0%, respectively, p = 0.005). Girls younger than 23.3 months showed a significantly higher resolution rate to topical estrogen treatment (100% vs. 86.7%, p = 0.043). Side effects and recurrences occurred exclusively in children treated with topical estrogen therapy without significant differences compared to the observation group.

CONCLUSION

Topical estrogen therapy showed a higher resolution rate than observation for the treatment of prepubertal girls with labial adhesions, especially in younger girls.

Labial Adhesion: New Classification and Treatment Protocol

STUDY OBJECTIVE

To determine the subtypes of labial adhesion (LA) and arrange treatment options accordingly.

DESIGN AND SETTING

Patients who presented to our clinic with LA between July 2016 and February 2018 were divided into 4 groups. Location of the adhesion area, thickness of the adhesive tissue, and response to topical steroid (betamethasone valerate 0.1% ointment) therapy were identified as common features.

PARTICIPANTS

Seventy-five prepubertal girls.

INTERVENTIONS AND MAIN OUTCOME MEASURES

To determine the subtypes of the LA and evaluate the treatment response of patients in each subtype group.

RESULTS

LA was divided into 4 subtypes according to their common characteristics. For patients with type I, 2 weeks of topical steroid treatment resulted in complete recovery (100%). For those with type II, 12 (80%) patients had complete response to topical steroid treatment for an average of 3 weeks. Type III and IV patients were completely unresponsive to topical steroid treatment.

CONCLUSION

Classification of LA patients into subtypes and determination of treatment on the basis of this classification make a major contribution in planning the treatment of patients, not by trial-and-error, but using a predetermined strategy.

Treatment of Prepubertal Labial Adhesions: A Randomized Controlled Trial

STUDY OBJECTIVE

Although various treatment options have been proposed for the treatment of labial adhesions, there are currently no clearly outlined limits on the duration of topical therapy, amount of lateral traction to apply, and methods to decrease the recurrence. This clinical trial was undertaken to assess the need for estrogen for treatment of prepubertal labial adhesions.

DESIGN

Randomized, double-blinded, controlled trial.

SETTING

Pediatric and Adolescent Gynecology Clinic at a children's hospital in a metropolitan area.

PARTICIPANTS

Prepubertal girls ages 3 months to 12 years with labial adhesions.

INTERVENTIONS

Lateral traction with topical estrogen or topical emollient.

MAIN OUTCOME MEASURES

The primary outcome was resolution of labial adhesions. The secondary outcome was the change in severity of labial adhesions over time between the 2 groups.

RESULTS

Forty-three girls were enrolled and 38 (88%) completed the study. The difference in complete resolution between the topical emollient group (19%) and the topical estrogen group (36%) was not statistically significant (P = .21). There was a statistically significant decrease in severity of labial adhesions over time, with the magnitude of improvement favoring the topical estrogen group.

CONCLUSION

Although labial adhesion severity decreased when treated with lateral traction and topical emollient or topical estrogen, the magnitude of the effect was significantly greater for topical estrogen.