Comparison of Conservative and Surgical Therapy Concepts for Synechia of the Labia in Pre-Pubertal Girls

Abstract

Introduction: The aim of this study was to evaluate the primary and secondary therapeutic successes of different therapy schemes for the treatment of synechia of the labia in pre-pubertal girls. Materials and Methods: The treatment courses of 47 pre-pubertal girls who were treated between February 2007 and February 2013 in the special outpatient clinic for paediatric gynaecology of a department for gynaecology at a German university hospital and for whom information on the course of the disease was available for at least the six months following end of the treatment. 23 of these children were treated with a topical estriol therapy (treatment group A). For 24 of the girls a manual separation of the adhering labia minora was undertaken (treatment group B). Statistical evaluation was performed using the ?2 test, Fischer?s exact test and the Mann-Whitney U test. Results: For 18 of the 23 (80?%) girls in treatment group A topical estriol therapy alone led to a resolution of the synechia. Five of these 23 children (20?%) required a secondary manual separation. All girls for whom treatment was not successful were under 5 years of age. For all 24 girls (100?%) of treatment group B the primary manual separation was performed with success. The recurrence rates after ??6 months in cases with identical after-care did not differ between the two treatment groups (treatment group A: 34?%, treatment group B: 33?%, ?2 test: p?=?0.853). 16 of the 17 recurrences occurred ??3 months after the end of the therapy. Conclusion: Our results show that for children <?5 years of age a 4-week topical therapy with estriol is a promising therapy option for synechia of the labia that is less of a burden for the family situation. Especially for girls ??5 years of age, primary therapy fails in up to 20?% of the cases. Primary manual separation represents a more effective therapeutic option. Irrespective of the treatment applied, a recurrence after ??3 must be expected in one-third of the treated girls.

Spontaneous resolution of labial adhesions in pre‐pubertal girls

“…6-8 There is a large body of literature comparing different treatment modalities for labial adhesions, with widely variable results. 1,6,[9][10][11] However, little research addresses whether the condition actually causes the symptoms that have been attributed to it and the optimal management when symptoms or concerns are present. Labial adhesions are not present at birth, occurring most commonly between 6 months and 2 years of age.…”

“…Topical oestrogen cream is commonly utilised, with reported efficacy rates of 15.5–100%, although recurrence rates of up to 34% have been reported . Topical steroids are also used with similar efficacy .…”

Sinequia vulvar: revisión de literatura

“…2,9,16,24 Para este caso, se utilizan ungüentos/cremas que contengan estrógenos conjugados o estradiol al 0,01%. La aplicación se realiza administrando una pequeña cantidad del ungüento sobre el rafe medial.…”

“…Su empleo debe hacerse 1 o 2 veces al día por 2-6 semanas. 2,3,16,25 Dentro de los efectos adversos reportados con su uso, se encuentran la irritación local, hiperpigmentación de la vulva, telarquia, sangrado vaginal y desarrollo de vello púbicohasta la inducción de pubertad precoz. Los efectos adversos, por lo general, desaparecen con el cese del tratamiento.…”

“…14 El factor presente en todos los casos es el daño superficial de la mucosa. 3 Las lesiones también son consecuencia de procesos infecciosos, como vulvitis o vulvovaginitis, 1 o mecánicos, como limpieza excesiva, 15 dermatitis grave por contaminación con heces 16 o posición de los labios menores con el uso del pañal. 8 A pesar de que esta línea de eventos fisiopatológicos es coherente y están presentes como factores asociados en muchos casos, estudios recientes han demostrado que no existe correlación con la frecuencia del cambio del pañal, presencia de infección, procesos alérgicos, uso de los anticonceptivos orales por parte de la madre antes del embarazo o algún antecedente familiar.…”