From the Research
Labial adhesions in prepubertal girls should be treated with topical estriol + testosterone as an alternative therapy for those refractory to standard topical treatments, as suggested by the most recent study 1.
Treatment Approach
The treatment of labial adhesions depends on the severity of symptoms and the extent of the adhesion.
- For asymptomatic, minor adhesions, observation alone is appropriate as many resolve spontaneously with puberty.
- For symptomatic or extensive adhesions, the first-line treatment is typically topical estrogen cream, but the recent study 1 suggests considering topical estriol + testosterone for cases unresponsive to standard therapy.
Topical Treatment
Topical estrogen cream, such as conjugated estrogen or estradiol 0.01%, applied to the adhesion line twice daily for 2-4 weeks, is a common first-line treatment.
- A thin layer should be applied using a cotton swab or fingertip.
- Parents should see improvement within 1-2 weeks, with complete resolution often occurring within a month.
Prevention of Recurrence
After resolution, applying petroleum jelly to the area for several months can prevent recurrence.
- Good hygiene practices, including front-to-back wiping and avoiding irritating soaps, can also help prevent recurrence after treatment.
Surgical Intervention
For severe or persistent adhesions unresponsive to estrogen therapy, surgical separation under local anesthesia may be necessary, though this is rarely required 2, 3, 4, 5.
Pathophysiology
Labial adhesions occur due to low estrogen levels in prepubertal girls combined with inflammation or irritation of the genital tissue, creating raw surfaces that can fuse together.
- The role of androgens in the pathophysiology and therapy of labial adhesions is being explored, with some studies suggesting their potential significance 1.