By far the most common form of vaginal obstruction in little girls is fusion of the labia minora as a result of labial adhesions. These are typically diagnosed in girls from 6 months to 6 years of age. Diaper rash, infections, irritants, or mechanical trauma commonly cause chronic inflammation of the labia. Occasionally the inflammation is the result of chronic sexual abuse. Whatever the cause, as the labia try to heal, fibrous tissue adheres the labia to each other. Some girls are prone to forming adhesions no matter how careful the parents are. The adhesions result in a smooth membrane over the vulvar opening with a thin, pale line at the center. This surface membrane usually starts forming at the rear of the opening, and ‘zippers’ closed toward the front. Usually, a sufficient opening at the front remains to permit urine and vaginal secretions to exit.
The adhesions will often resolve spontaneously when girls are out of diapers or pull-ups both day and night. When labial adhesions persist, the estrogen surge at puberty will correct the problem. If there are no complications, such as infections or obstruction, the adhesions do not need to be treated. If treatment is needed or preferred, the natural process can be accelerated with the application of topical estrogen. A hormone cream, such as Premarin, should be applied twice daily for two weeks, and then nightly for an additional week, if necessary.
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