A 4-year-old girl presents with low-grade pyrexia and dysuria. A urine dipstick test shows positive results for leucocytes and nitrite, suggesting urinary tract infection. On examination, you notice partial adherence of the vulval labia minora. Her mother reports that the girl has intermittently had discomfort in the genital area over the last year. While waiting for the results of the urine microscopy, you remember that one of your colleagues has mentioned treating labial adhesions with oestrogen creams in the past. You wonder whether there is good evidence to support their use in this condition.

Structured clinical question

In a girl with labial adhesions (patient), is oestrogen cream (intervention) an effective treatment to induce labial separation (outcome)?

Search strategy and outcome

Cochrane Library using the terms “labial adhesion AND treatment”, “labial adhesion AND management” and “labial adhesion and oestrogen/estrogen” as well as three alternative terms for labial adhesion (“labial fusion”, “labial agglutination”, “synechia vulvae”) in combination (AND) with “treatment”, “management”, “oestrogen” and “estrogen”. No relevant results.

PubMed (1975–2006) using the same search terms (no limits set). Search date: 21/05/06. Search outcome: a total of 207 matches for all searches combined—147 articles in total. Only three were relevant.^1–3

In addition, we retrieved and evaluated publications that were cited as references in the three articles found in the initial literature search. This method identified two more relevant articles.^4–5

Commentary

Labial adhesion, also termed labial agglutination, labial fusion and synechia vulvae, is not a rare condition and has been reported to occur in up …