Labial agglutination and infection in prepubertal girls

Abstract

Objectives: To assess the correlation of previous infections with the frequency of labial agglutination, to confirm the effectiveness of oestrogen therapy and the frequency of positive microbiological swabs after treatment. Methods: The study included 88 girls aged from 3 months to 10 years who have been examined at the Gynaecological outpatient unit of Children’s Hospital Zagreb from 2005-2007. Anamnestic data about previous infections were obtained from the parents. All girls were treated with an oestradiol cream twice a day. The patients were then re-examined 2 weeks and/or 4 weeks later. After the treatment, vaginal and vulvar smears were taken for microbiological analysis. Results: Twenty-eight (31.8%) girls were lost to follow up. Out of 60 girls in 27 (45%) girls we learned about a previous respiratory or urinary infection in the 3 months before our exam. 45/60 (60%) girls presented with complete agglutination, but without urine disturbances and 15/60 (25%) had partial fusion. After 2 weeks of treatment we found complete resolution in 16/60 (26.7%) cases, after 4 weeks in 30/60 (50%) cases, and after 4-6 weeks of local hormonal treatment in 14/60 (23.3%) cases. Out of 60 study patients’ culture in 27 (45%) the causative agents were isolated from the vaginal culture. Agglutination subsequently recurred in 20/60 children (33.3%), mostly in association with respiratory infection Conclusion: Topical oestrogen application is the method of choice in the treatment of labial agglutination, but for at least 4 weeks of application. Recurrence of agglutination is common and mostly associated with infection. It could be reduced by application of a lubricant to lysed surfaces for as long as 6 months after lysis and at the time of infection.