Topical estrogen therapy in labial adhesions in children: therapeutic or prophylactic?

To evaluate the efficacy of topical estrogen therapy as a therapeutic or a prophylactic agent in labial adhesions in children.

Patients who were diagnosed with labial adhesions were evaluated in three different groups according to a modified algorithm. A conservative treatment (CT) group consists of asymptomatic patients who did not receive any treatment previously. They received only topical estrogen twice a day for 14 days. A manual separation (MS) group includes patients who were symptomatic and unresponsive to medical therapy. Only manual separation was performed. Symptomatic patients who had not received any treatment were enrolled as manual separation with prophylaxis (MSP) group. Manual separation with postoperative prophylactic topical estrogen was the choice of treatment in the last group. Manual separations were performed in an outpatient facility with local anesthesia. All patients were followed up after 3 and 9 months.

In total, 49 patients were enrolled in the study. Mean age of patients was 14.05 +/- 4.19 (n =18), 14.64 +/- 4.60 (n =14) and 12.82 +/- 4.34 (n = 17) months for conservative treatment, manual separation, and manual separation with prophylaxis groups respectively. Success rates of the CT group was 66.6% (n = 12) in the third month and 55.5% (n = 2) in the ninth month. Recurrence was experienced in two (11%) patients. The MS group had a success rates of 85.7% (n = 12) in both 3(rd) and 9(th) months and recurrence was 14.2% (n = 2). All of the patients treated (100%, n = 17) by manual separation with prophylaxis recovered when followed up at three and nine months. No patient needed surgical intervention. The conservative group had significantly lower success rates when compared to other groups (P = 0.002). No statistical difference was detected between MS and MSP groups (P = 0.196).

Labial adhesion is a common gynecologic problem in childhood. Asymptomatic patients also require treatment in which topical estrogen therapy is adequate. Topical estrogens have limited satisfactory results with considerable adverse events. Manual separation should be performed for symptomatic patients. Topical estrogens prevent recurrences when used as prophylaxis after manual separation in labial adhesions.