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You are seeing a 3-year-old girl with dysuria and urinary frequency. Her urine sample shows pyuria consistent with a UTI. She recently took antibiotics 2 months ago for an E. Coli UTI. She has been potty-trained for 6 months and is not having any accidents. However, her parents state that she often has discharge on her underwear. On exam, you find that her labia majora are fused approximately 50% of the way up from the fourchette. You plan to prescribe antibiotics for the UTI.
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September 10, 2025 at 2:39 pm
E) Either B or C
Labial adhesions are commonly seen in young pre-pubertal girls, with a peak incidence in the second year of life. They can be asymptomatic, or they can lead to urinary stream difficulties, dribbling, vaginal discomfort and/or discharge, and recurrent UTIs. If asymptomatic they can be left alone although when most of the labia are fused treatment is often initiated. This patient is symptomatic and warrants treatment. Either topical estrogen cream 0.625mg/gm or topical 0.01% estradiol or topical 0.05% betamethasone can be gently applied to the fused area using a cotton swab in a thin layer twice a day. Topical estrogens carry a small risk of systemic absorption leading to side effects such as breast bud development and vaginal bleeding. Parents should be told that successful treatment may take 4-8 weeks, and they should follow-up with their pediatrician. Vaseline may be used after successful separation. Manual or surgical separation is rarely indicated and reserved for significant symptoms such as complete urine flow obstruction.