Labial adhesions occur in up to 2% of girls usually in the first 2 years of life:
The cause has not been clearly identified. Some have postulated that they are due to low estrogen levels and others say they are due to irritation or trauma.
Most labial adhesions produce no symptoms. Occasionally, they can result in urinary dribbling due to urine trapping inside the vagina behind the adhesions. Some children present with recurrent urinary tract infections.
I recommend observation for most asymptomatic girls due to the fact that 80% of vaginal adhesions resolve spontaneously.
For symptomatic patients treatment is reasonable:
Although estrogen creams are usually recommended by pediatricians, I prefer to only use Vaseline with gentle traction to avoid potential estrogenic side effects (breast growth, mood changes).
When the patient is cooperative, topical anesthesia can be applied to the adhesions in the office and then gentle retraction or a blunt instrument is used to divide the adhesions. There is usually no bleeding involved. The family is asked to apply vaseline a few times a day for a few weeks to keep things open.