An approach to management of labial adhesions in prepubertal females

* The choice of topical therapy requires shared decision-making with caregivers regarding potential side effects related to systemic absorption. These include local irritation, vulvar hyperpigmentation, breast bud formation, and minimal vaginal bleeding with estrogen creams and, if applied excessively or for longer than 3 months, skin atrophy and systemic absorption with betamethasone cream. Topical (vaginal) estrogen cream is supplied as equine estrogen 0.625 mg/gram or estradiol 0.1 mg/gram.
¶ Small, asymptomatic labial adhesions typically resolve spontaneously but may recur. Adhesions resolve completely with estrogen production at puberty.
Δ Complete resolution of labial adhesions may take a few weeks to several months, depending on the degree and extent of fusion. After resolution, the caregiver should prevent recurrence by applying petroleum jelly or similar bland ointment daily for 6 to 12 months and having the child adhere to vaginal hygiene measures (refer to UpToDate content on vulvovaginal hygiene measures in prepubertal females).