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Labial Adhesions
Case
The mother of a 7 month old girl comes to
the office because she can not see the babies vagina when she changes
the diaper. The baby is otherwise doing well and has frequent wet
diapers. How would you treat this patient?
Labial adhesions are common in females
between the ages of 4 months and 6 years. It results from the presence
of inflammation secondary to irritation in a low estrogen environment,
thus it is not seen at birth and after puberty. There appears to be no
opening and the urethra is not visualized. Often referred for "absent
vagina" Rare incidence of urinary retention.
5% of prepubertal girls and up to 10 % of
girls<12 months of age
Etiology
- Most common, there is a non-specific
vulvovaginitis that is asymptomatic.
- Poor hygiene
- Enterobiasis vernicularis
- Candida infection
- Group A Streptococcus, sometimes
associated with throat infection
- Symptomatic infections
- Gonococcal infections
- Trichomonas infections
- vaginalis
- Gardenella vaginalis
Management
- Examination should detect the labial
agglutination and your exam should include looking for signs of
infection, rash, discharge, and sexual abuse.
- If there are signs of a urinary tract
infection, a sterile urine culture should be done.
- Emphasize good hygiene
- anterior to posterior
- change diapers more frequently
- change underwear daily
- Estrogen cream applied nightly for twice
daily with finger over the fusion line. Stop treatments if breast
buds develop. 50-100 % success rate.
- Majority of cases will resolve without
any therapy within 18 months. Therefore, reassurance is all that is
necessary in most cases. If you manually break the adhesions, they will
reform unless you put petroleum jelly on the edges. This may also
traumatize the patient.
- Reassurance and rarely is there a need
to send to gynecologist for evaluation.
References
- Labial Adhesions. Pediatrics in Review
March 1994
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