Labial Adhesions Mostly Treated Non-Surgically

Source: O’Keefe RJ, Compton SD, Dendrinos ML, et al. Management variation in pediatric labial adhesions: a retrospective cohort study. J Pediatr. 2025 Jun:281:114529; doi: 10.1016/j.jpeds.2025.114529.Investigators from the University of Michigan, Ann Arbor, MI, conducted a retrospective study to describe variations in the management of girls with labial adhesions (LA) and assess outcomes in patients treated with surgical adhesiolysis. Participants were patients ≤21 years old seen at a single institution who were diagnosed with LA between July 2022 and June 2023. The medical records of study patients were reviewed and demographic and clinic data abstracted. The type of clinician, eg, primary care provider (PCP), making the diagnosis of LA was noted, and providers treating girls with LA were classified as PCP, pediatric and adolescent gynecologist (PAG), pediatric urologist (PUR), and other. Types of treatments were categorized as observation, topical, manual traction in the clinic, and surgical. Surgical adhesiolysis was classified as either blunt (ie, with a coated cotton swab) or sharp blade (scissors). The rate of use of each type of treatment was calculated. For patients treated with surgery, the recurrence rate was also determined.Data were analyzed on 159 girls with LA. The age of study patients ranged from 0 months to 8 years at diagnosis, with a median of 12 months. The initial diagnosis of LA was made by a PCP in 140 (88.1%) cases, primarily by a pediatrician (N = 134; 84.3%). Among the participants, 81 (50.9%) were managed by the diagnosing PCP, and 78 (49.1%) were referred to a subspecialist (41 [59.0%] to a PUR, 32 [41.0%] to a PAG, and 5 [6.4%] other). There were 41 girls who presented with urinary symptoms, including 28 (17.6%) with a history of urinary tract infection and 13 (8.2%) with dysuria, postvoid dribbling, or urinary retention. Initial therapy included topical treatment in 132 (83.0%) girls, observation in 25 (15.7%), and manual traction in 2 (1.3%). Overall, topical estrogen was prescribed to 111 (69.8%) patients, topical emollient to 101 (63.5%), and topical betamethasone in 9 (5.6%). Ultimately, 140 (88.1%) girls were managed without surgery. There were 19 (11.9%) patients treated surgically, 8 by PAGs, 10 by PURs, and 1 by an adult surgeon. The mean time from diagnosis of LA to surgery was 28 months for girls treated by PAGs and 18 months for those managed by PURs (P = 0.38). Blunt adhesiolysis was the surgical treatment in 11 patients, and sharp adhesiolysis in 6, with sharp adhesiolysis performed exclusively by PURs. LA recurred in 6 (31.6%) of girls treated surgically, at a median age of 5.0 years.The authors conclude that most girls with LA were managed without surgery.Dr Goyal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.LA are a common condition in prepubertal girls, thought to arise from a state of naturally low estrogen, but also triggered or exacerbated by factors such as trauma or poor hygiene.1 The AAP recommends observation alone for asymptomatic LA, as most cases will resolve spontaneously within a year.2 However, symptoms of LA can include dysuria and dysfunctional voiding; for such cases, treatment is indicated and typically will begin with topical estrogen or betamethasone.3 Given the frequency of this condition and range of possible referral and treatment options, a better understanding of practice variation and outcomes is needed.The current authors conducted a single-center study of children with LA to measure rates of various treatment approaches (observation, topical, manual traction, surgical adhesiolysis) and their associated outcomes.4 Consistent with the known epidemiology of LA, most children were diagnosed with LA by age 2, and most were treated with non-surgical interventions. Of the few patients treated surgically, approximately one-third experienced LA recurrence. Of note, children in the study had relatively high rates of referral to subspecialty care (49.1%), and over 80% of the overall sample were initially managed with a topical therapy vs observation alone (15.7%). This may reflect a bias in sampling toward children with more persistent or symptomatic LA, as reliance on diagnosis codes in medical records would exclude those with asymptomatic LA that was either undiagnosed or diagnosed but not coded by a pediatrician recommending observation only. As acknowledged by the authors, the small sample size and retrospective design of the study limited the ability to identify meaningful differences in outcomes across surgical treatment strategies; interpretation also was limited by confounding by indication. Future research may incorporate a larger sample size and prospective study design to further evaluate optimal surgical and non-surgical approaches for LA.Most children with LA are treated conservatively, with surgical treatment reserved for a small percentage of children.