{ "schema_version": 1, "kind": "condition", "id": "labial-adhesions", "name": "Labial adhesions", "category": "chronic", "sources": "Labial Adhesions - StatPearls (NCBI Bookshelf NBK470461) - https://www.ncbi.nlm.nih.gov/books/NBK470461/ · Labial adhesions - disease-level clinical article (labial-adhesions-full.txt) · Labial adhesions - disease-level clinical article (labial-adhesions-clinical.txt)", "review_status": "reviewed", "verified_against": "Labial Adhesions - StatPearls (NCBI Bookshelf NBK470461) - https://www.ncbi.nlm.nih.gov/books/NBK470461/ · Labial adhesions - disease-level clinical article (labial-adhesions-full.txt) · Labial adhesions - disease-level clinical article (labial-adhesions-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1059, "generic": "Reassure and leave it alone if she has no symptoms (Recognition & Advice)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Labial Adhesions - StatPearls (NCBI Bookshelf NBK470461) - https://www.ncbi.nlm.nih.gov/books/NBK470461/", "rationale": "Most of these need nothing at all, and the commonest harm done is by treating them. The card leads with that, and the topical oestrogen row below is for the girl who actually has symptoms.", "cautions": [ "MOST ARE FOUND BY ACCIDENT AND MOST NEED NOTHING - the history and the examination usually turn up nothing the child complains of; labial adhesions are typically noticed in passing while the genitalia are being looked at for some other reason. Where there are no symptoms, management starts and often ends with reassurance and advice on hygiene, since as many as 80% separate on their own inside 1 year.", "WHAT COUNTS AS SYMPTOMATIC - a girl with symptoms may describe dribbling after she has finished passing urine, pain on passing it, blood in it, a sore or inflamed labia, or retention. The fused tissue can hold urine back, and that is what the delayed dribble is. Repeated urinary infection counts too: a prepubertal girl with labial adhesions catches more of them, and separating the fusion brings that risk down.", "SO THE THRESHOLD FOR TREATING IS EXPLICIT - treat once symptoms appear, or once the urinary infections start repeating. Short of that, reassurance and advice on hygiene remain the right answer, because a great many of these adhesions come apart of their own accord given time.", "PARENTS MUST NOT PULL THEM APART - tell the parents not to try separating anything at home: it hurts, and it scars. This is the single instruction most likely to prevent harm, and it needs saying before the family leaves.", "AND NEITHER SHOULD YOU, REPEATEDLY - separating them in the clinic over and over can leave the adhesions thicker than they were. Forceful separation trades a harmless finding for a scarred one.", "PREVENT THE IRRITATION THAT CAUSES IT - keeping the perineum clean, staying away from irritants such as harsh soap or too much wiping, and dealing with any chronic inflammation or skin condition, all make an adhesion less likely to form. In particular: no scented soap, no bubble baths, no strong detergents, and get a wet nappy or swimming costume off promptly. Wipe front to back, which irritates less and keeps urinary infections away.", "A BARRIER OINTMENT AFTERWARDS IS WHAT STOPS IT COMING BACK - a barrier ointment, white petroleum jelly for instance, put on twice a day once the adhesion has been treated or separated, keeps the area moist and protected and stops it re-forming. Care after the procedure runs on with the topical oestrogen and the barrier ointment for the same reason.", "EXPECT RECURRENCE AND SAY SO - whatever the treatment, it comes back in somewhere between 11% and 14% of girls, and can keep doing so until puberty. The family should know it may come back and that this is not a failure. Puberty ends it: most settle as the oestrogen rises around then.", "WHEN IT STOPS BEING A PRIMARY-CARE PROBLEM - where the topical treatment fails, surgery becomes worth considering - gentle traction under a general anaesthetic. Urinary retention, a vaginal opening you cannot identify at all, or failed topical treatment goes to paediatric surgery or urology.", "AND THE THING THAT IS NOT COVERED HERE - fused labia in a girl with any other genital abnormality, virilisation, or a history that raises concern about interference is not a routine labial adhesion. Assess it as a genital examination in its own right and involve a paediatrician." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "labial-adhesions" }, { "id": 1060, "generic": "Topical estrogen cream", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Not an adult indication in this article - the cached document describes prepubertal girls. Apply a small amount to the fusion line only.", "adult_duration": "Up to 6 weeks; some authors extend to 3 months", "dose_source": "Labial Adhesions - StatPearls (NCBI Bookshelf NBK470461) - https://www.ncbi.nlm.nih.gov/books/NBK470461/", "rationale": "Indication: a topical estrogen cream is what the article puts first for labial adhesions. Amount: because the paediatric evidence for long-term use is thin, it is applied for the shortest stretch that works - as a rule once or twice a day, for as long as 6 weeks. The article reports it succeeding in as many as 90% of cases.", "cautions": [ "IT IS ABSORBED, SO KEEP IT SHORT - topical oestrogen can make the breasts tender and can darken the skin where it is applied. The article's own reason for the six-week ceiling is that little is known about using it in children for any length of time. Breast budding or vaginal bleeding in a prepubertal girl means stop and reassess.", "DO NOT START IT IN A GIRL WITH NO SYMPTOMS - the article's plan goes in steps: watch where there are no symptoms, treat topically where the adhesion is mild or moderate, and operate where it is severe or will not respond. Treating a symptomless incidental finding exposes the child to a hormone for nothing.", "THE STEROID ALTERNATIVE, AND ITS OWN COST - a corticosteroid such as beclometasone is the other topical option, and works about as well as oestrogen, with no statistically significant difference between them. But a topical steroid can thin the skin, and bring folliculitis, redness, thinning of the hair or itch. Either is reasonable; neither should run on indefinitely.", "FOLLOW IT UP RATHER THAN REPEATING THE PRESCRIPTION - at follow-up, look for signs it is returning and for urinary symptoms, and get advice quickly if either appears. A course that has not worked in six weeks is a referral, not a repeat.", "TEACH THE APPLICATION OR IT WILL NOT WORK - where there are symptoms, the girl and her family need teaching: how to apply the treatment properly, what side effects to expect, and why finishing the course is what makes it work. Cream smeared over the vulva treats nothing and increases the absorbed dose." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "A topical application, not a weight-based dose, so the per-kilogram fields are empty on purpose. The article gives a frequency and a duration - once or twice a day, for as long as 6 weeks, with some authors carrying treatment on to 3 months - but it names no particular estrogen and no strength. Choose the local preparation and apply the smallest amount that reaches the fusion line, with a cotton bud, not to the whole vulva.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "labial-adhesions" } ] }