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- Wed Feb 10, 2010 1:29 pm
My daughter's pediatrician noticed that her labia were partially fused (half closed over her vagina) at 4 months. Since then we have tried 4 rounds of estrogen cream (applied at first once a day, then later twice, and later 3 or more times a day for a month at a time), to no effect. Her labia are now completely closed with only an opening at her urethra. She is now 2 and a half. We have a new issue now that we are potty training and are having trouble in that the angle of the opening is such that it causes her urine to stream out the top, on to the potty or toilet seat, or on to her clothes.
I hadn't sought out a second opinion as everyone and everything we read indicates that this will self-resolve and isn't a problem unless she develops a UTI. I'm concerned though that we're not doing enough and that by not doing anything more aggressive we're letting the fusing become more permanent or causing a larger problem for later. Is that possible? We're obviously concerned about the urinating issue now too. Should she see a gynecologist or continue with our pediatrician? As an aside, our daughter has extreme anxiety about exposing herself at the doctor's office. The last visit was very traumatic and I'm a little afraid to return to our (older and large, male) pediatrician in case we have a repeat performance.
Thanks so much for your help,
a distressed and concerned parent.
| Dr.M.Aroon kamath
- Sun Mar 14, 2010 12:13 am
peak incidence of fused labia minora (labial adherance) is between 3 months and 2 years of age and peaking again betweeen 6-7 years.In the new-born period, maternal estrogens seem to protect against fusion. Differentia diagnoses include vaginal agenesis,imperforate hymen,scarring of labia minora,clitoral hypertrophy, intersex disorders, & childhood sexual abuse.
Most cases resolve spontaneously by one year of age(about 80%).
Generally treatment is deferred.For cases that do not resolve spontaneously,topical estrogen creme may be tried.Success of estrogen creme is reported to be about 90% at 8 weeks.
Persisting adherence may be an indication for gentle,blunt,manual separation under topical anesthetic such EMLA creme.
Following may be the usual indications...
- failure to respond to topical estrogens,
- very symptomatic(recurrent UTIs,post-void dribbling on standing up),
- parental anxiety & preference.
Prevention of the separated labia must be meticulous by
- daily separation of the labia &
- application of petroleum jelly or other water soluble ointments.
Recurrence rates are fairly high.The condition usually resolves at puberty possibly due to spurt in estrogen levels.