Prepubertal labial adhesions: evaluation of a referral population.

OBJECTIVE The purpose of this study was to assess patient demographics, clinical presentation, response to previous treatment, and current evaluation of prepubertal girls referred for gynecologic care of labial agglutination. STUDY DESIGN A retrospective chart review of all prepubertal female patients with labial agglutination referred from 1996 through 2001. RESULTS Twenty-three girls were diagnosed with labial agglutination during the review period. All of the diagnoses were made by a primary care provider. At the time of referral, most patients had received medical therapy, but had not obtained resolution of their labial agglutination with topical estrogen. Twenty-two of the 23 patients required manual separation of the labial adhesions. Findings most frequently revealed a pinpoint opening and thick (3-4 mm) adhesions with >90% of the vestibule adhered in 21 of 23 girls. Nine of 23 girls had recurrence of adhesions. Four girls required a repeat manual separation because of recurrent thick adhesions. One of 4 girls required a third manual separation. Five of the 9 recurrences were treated successfully with topical estrogen. CONCLUSION Gynecologists who treat patients with labial agglutination frequently may encounter children for whom medical treatment has failed. Patients whose condition does not respond to topical therapy may have thick adhesions and require manual separation.