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Treatment Deemed Unnecessary for Most Pediatric Labial Agglutination


 

HOUSTON — Labial agglutination resolves spontaneously at puberty in up to 80% of girls and has a 40% recurrence rate after treatment, whether medical or surgical, making nontreatment the best option when patients are asymptomatic, according to Dr. Abbey B. Berenson, professor of obstetrics and gynecology at the University of Texas at Galveston.

“There is only one case report of this leading to urinary retention,” she said at a conference on vulvovaginal diseases jointly sponsored by Baylor College of Medicine and the Methodist Hospital. “That's why I don't start treatment when they're asymptomatic. You could end up taking them to the OR just so they look normal, and you don't want to do that.”

Extensive labial agglutination is present in 5% of prepubertal girls and up to 10% of girls aged 12 months or under, she said. Patients are usually referred with the chief complaint of “absent vagina” because there may be only a small opening visible below the clitoris. Although the majority of patients are asymptomatic, some may have urinary symptoms. “The vagina can form a sort of pocket in which urine gathers and then dribbles out. These are the ones you want to treat because you don't want to see kidney damage due to repeat urinary tract infections or urethritis,” she said.

Dr. Berenson recommends topical estrogen cream as first-line treatment.

“I really think it's important to try and avoid surgery,” she said in an interview. “It is such a big deal to take these children to the operating room, and so often the problem recurs anyway.”

The success rates for estrogen medical therapy range from 50% to 100%, she said. “This works for thin adhesions but not thick or recurrent ones.” Parents should be instructed to use a finger to apply the estrogen cream over the gray fusion line using some pressure. This should be done twice a day for 2–4 weeks but stopped if breast budding occurs.

The risk of recurrence can be lowered with good hygiene and reduced irritation, because the condition is believed to develop as a result of low estrogen levels and local irritation, which injures tissue and results in adherence of the labia minora.

Surgical treatment should be reserved for those who fail medical therapy, Dr. Berenson said.

It's important to try and avoid surgery. It is such a big deal to take these children to the OR. DR. BERENSON

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