Labial adhesions in asymptomatic prepubertal girls: to treat or not to treat

Clinical scenario: a two year old girl is taken to the office for a well child care control. Labial adhesions are noticed in the clinical exam. The parents ask about the reason of this condition and, more important, if it is necessary to treat it. You know the topical treatment with estrogens, but you doubt about its effectiveness and if it is indicated if the girl is asymptomatic.

Clinical question: in small girls with labial adhesions, is the estrogen topical therapy indicated?

Justification: labial adhesions is one of the most frequent gynecologic disorders in prepubertal girls; 1.8% of them suffer from it during some time in their lives. The highest incidence (3.3%) happens between 13 and 23 months of age. Topical estrogens have been used as the initial therapy in most of the cases, although manual separation or even surgery have been undertaken, especially in severe cases. However, the indication and effectiveness of the mentioned treatments are not clear. The long time prognosis of these procedures is not known either.

Clinical scenario resolution: when the parents come back to the office, you explain them that due to the fact that the girl doesn’t have symptoms, there is the possibility that the adhesions solve spontaneously with time, and not treating them initially doesn’t increase the risk of symptoms, so that you don’t consider to start any kind of therapy. You agree with the family on a clinical follow up and explain them the symptoms to keep watch on; also, you inform them on the existing possibilities of therapy in case the girl stopped been asymptomatic.