| Leung et al (2005) |
20 girls aged 2–38 months treated with oestradiol cream (0.625 mg/gwt) twice daily |
Prospective case series – single centre (level 4) |
Separation of labia,
Recurrence rate |
All patients responded to treatment
(100%/95% CI, 83.9% to 100%) |
Petroleum cream/Vaseline was used topically bd for 1 month after separation occurred. |
| In all patients fusion covered at least 50% of the vaginal opening. |
Side effects: breast enlargement in one patient (transient), vulval pigmentation in five patients (transient) |
| Duration of treatment variable depending on response (range 1–3.5 months/mean 2.4 months). |
No recurrence during follow up |
Relatively short follow‐up period (true recurrence rate may be higher) |
| Follow‐up variable (range 2.5–4 months) |
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| Muram et al (1999) |
262 prepubertal girls with labial adhesions treated with conjugated oestrogen cream
(0.625 mg), manual separation with topical anaesthetic or surgical separation. Three girls required surgical separation owing to urinary retention before oestrogen treatment. 259 girls were treated with oestrogen cream initially/duration of treatment: 10–14 days |
Retrospective case series – single centre (level 4) |
Separation of labia,
recurrence rate |
Treatment with oestrogen cream was successful in 121 patients (46.7%/95%
CI, 40.7% to 52.8%). 14 (11.6%) of these patients had a recurrence and underwent manual separation or surgery. |
Success of oestrogen treatment was more likely in patients with thin, transparent adhesionsDaily frequency of oestrogen application not mentioned. |
| Similar recurrence rates with patients undergoing manual separation (16.7%) and surgical separation (15.4%) |
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| No details about follow up given (true recurrence rate may be higher) |
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| Khanam et al (1977) |
75 girls aged 3 months to 4 years. 50 were treated with oestrogen cream (0.01%
dienoestrol) and 25 had surgical separation electively. Complete fusion was present in 80% of patients (60/75).
Duration of treatment: 2–8 weeks |
Prospective case series – single centre (level 4) |
Separation of labia,
Recurrence rate |
Treatment was successful in 90% (95% CI, 78.6% to 95.6%) of patients treated with oestrogen cream and in 60% (95% CI,
40.6% to 76.6%) of those treated with surgery alone. |
Side effects not reported. |
| Daily frequency of oestrogen application not mentioned. |
| No details about follow up given (true recurrence rate may be higher) |
| Aribarg (1975) |
25 girls aged 2 months to 2 years treated with 0.01% dienoestrol cream once daily
(all classified as severe cases). |
Case series – single centre (level 4) |
Separation of labia,
recurrence rate |
Treatment was successful in 22 children (88%/95% CI, 69.8% to 95.6%). Only one patient (4.5%) had recurrence during follow up. |
Frequent side effect: vulval pigmentation (transient). One child had vulval erythema. No systemic side effects observed |
| Control group of 5 girls treated with bland cream only |
| Duration of treatment was variable,
depending on response (1 week to a maximum of 8 weeks). |
The five girls in the control group showed no improvement, but were subsequently successfully treated with oestrogen cream |
| Follow‐up over at least one year |
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| Capraro and Greenberg
(1972) |
50 girls aged 2 months to 14 years treated with oestrogen cream.60% of patients had complete fusion of the labia minora. Oestrogen cream was applied twice a day for 2–4 weeks |
Prospective case series – single centre (level 4) |
Separation of labia,
recurrence rate |
47/50 had adequate follow‐up. 42/47 (89%/95% CI, 77.3% to 95.3%) had good response. Some cases required manual separation of the remaining fine adhesions |
Petroleum jelly, bland baby ointment or cortisone cream was used topically for several weeks after separation occurred. |
| Proportion of patients requiring manual separation of remaining adhesions not clear |
| Side effects: three patients had breast tenderness (transient) and three patients had vulval pigmentation (transient). |
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No details about follow up given (true recurrence rate may be higher) |
