Management of Labial Fusion among Children: An Iraqi Experience

Abstract

ABSTRACT
Background: Labial fusion describes the apposition of labia minora which may be partial
or complete.
Objectives: To describe the modes of presentation among Iraqi girls with the indications
and efficacy of topical estrogen therapy in the treatment.
Methods: A prospective study of 26 female patients with labial fusion who attended a
private pediatric surgery clinic over the period from May 2010 till April 2014. Conservative
treatment was by application of topical estrogen cream at the site of adhesion for a
maximum period of 6 weeks. For Cases in whom conservative measures fail, surgical
separation was performed under general anesthesia. Patients were followed up for 3-6
months and the results were expressed in numbers and percentages.
Results: The mean age of the 26 girls was 9.34 months ± 7.91 (range 3 months to 3.5
years). Twenty two patients (80.8%) were asymptomatic, while five patients (19.2%) were
presented with urinary tract infection and/or perineal inflammation. Topical estrogen
therapy was started in all patients with a mean duration of 3.19 weeks ± 1.05 (range 1- 5
weeks). Seventeen patients (65%) showed resolution of the condition within 3 weeks of
hormonal treatment. Twenty three (88.5%) patients showed complete resolution of the
condition after 5 months follow up. Surgical separation is required in 3 patients with a
success rate of 100% after 3-6 months follow up.
Conclusions: Although asymptomatic cases need no treatment, the management plan
could be changed according to cultural bases of the community. Conservative measures
should be the first line of treatment in symptomatic patient. Surgical separation carries a
high successful rate, but it is reserved for failure of conservative treatment or recurrent
cases.