If you’ve spent any time examining toddlers with urinary complaints, chances are you’ve encountered pediatric labial adhesions — maybe without realizing it at first. It’s one of the more common yet under-discussed vulvar conditions in children, and the good news is that most of the time, management is simple, gentle, and completely in your wheelhouse.
Let’s walk through a clear, compassionate approach to treating labial adhesions, from watchful waiting or topical therapy to when it’s time to refer to pediatric gynecology.
Labial adhesions typically appear in girls between 3 months and 6 years old. They’re usually an acquired condition, not congenital. Low estrogen levels, combined with local irritation (from diapers, poor hygiene, infections, or inflammatory skin conditions), create the perfect storm for the labial minora to fuse in the midline.
But here’s the thing: if there are no symptoms, you don’t need to treat.
This is the cornerstone of conservative care. No dysuria? No post-void dribbling? No UTIs? Great! Offer reassurance. Most adhesions will separate spontaneously as estrogen levels rise with puberty. Parents may be understandably concerned about the appearance, especially if they weren’t expecting this at a well-child exam. Reassure them that this is common, harmless, and temporary.
If symptoms are present (think recurrent UTIs, urinary retention, dribbling, or vulvar irritation), then it’s time to intervene.
Here are some quick tips on how to use topical estrogen cream for labial adhesions:
What: conjugated estrogen (e.g., Premarin) or estradiol 0.01% (e.g., Estrace)
How: apply a pea-sized amount once or twice daily directly to the midline fusion, with gentle lateral traction during application. You can use a Q-tip or finger to apply.
Duration: 2-6 weeks
Side effects: transient breast budding or vulvar hyperpigmentation (rare) that resolves after stopping
Be sure to give anticipatory guidance to families about what to expect and not to panic if they see mild changes in the vulva. These effects are temporary and uncommon.
If topical estrogen is not well tolerated or there are contraindications, topical steroids are a reasonable alternative.
Here’s how to use topical steroid cream for labial adhesions:
What: topical betamethasone 0.05% cream
How: apply a pea-sized amount twice daily directly to the midline fusion
Duration: 4-6 weeks
Side effects: mild redness or skin thinning (both of which are temporary)
Some clinicians use steroids as a first-line option due to slightly lower recurrence rates. Evidence doesn’t strongly favor one treatment over the other, so clinical judgement and patient preference should guide the choice.
It’s important to counsel families that once the labia have separated, an emollient cream, like Vaseline, should be applied daily for several weeks to prevent the labia from re-fusing and forming labial adhesions again.
Check in after 4-6 weeks. If the adhesion is resolving and symptoms have improved, stop treatment and move into maintenance mode:
Gentle vulvar hygiene
Avoid irritants (bubble baths, fragranced soaps, wipes)
Treat vulvovaginitis or infections promptly
Adhesions may recur until a patient goes through puberty. If adhesions do recur, it’s okay to repeat a course of topical treatment. Persistent or thick adhesions that resist multiple courses may need further evaluation.
Most cases of pediatric labial adhesions can be managed comfortably in primary care. But a referral to pediatric gynecology may be appropriate when:
Adhesions are thick and completely occlusive
Symptoms are severe and persistent
The child has failed 2 or more treatment attempts
There is any uncertainty about diagnosis or concern for other pediatric vulvar conditions (e.g., lichen sclerosis, congenital anomalies)
Specialists can offer surgical separation if needed, but it’s rare. If surgery is performed, topical estrogen is usually continued for a few weeks afterward to prevent re-fusion.
Being able to recognize labial adhesions and knowing when to treat or not can spare families unnecessary worry and help you deliver compassionate, evidence-based care. It’s one of those conditions that shows up more often than clinicians expect.
For an even deeper dive, including practical tips and real-world scenarios, check out our May 2025 Peds Reviews and Perspectives episode, "Labial Adhesions", where they break down labial adhesions in their signature, clinically useful way.