A three-year old female presents with mild perineal irritation and dribbling of urine. On exam, a cotton tipped applicator can be inserted into what appears to be a single genitourinary opening.

 

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[size=20px]The most appropriate treatment of this child with a single genitourinary opening is

 

A continued observation.

 

B topical estrogen cream.

 

C vaginal dilations.

 

D surgical division.

 

E construction of neovagina.[/size]

D

think again my friend

C

(Untitled)

 

B

B

correct

 

Labial adhesions or fusion are a common problem in two to four year old girls. This fusion is thought to result from vulvovaginitis or other superficial irritation in which the skin becomes denuded and later fuses with healing. These adhesions typically form posteriorly and are often asymptomatic. However, the fused labia may obscure the hymen, urethral meatus and even clitoris. Urine may accumulate during micturition behind the fusion and within the vagina with gradual leakage responsible for the dribbling or additional irritation.

 

In the absence of symptoms no intervention is required apart from local hygiene. If there are problems or concerns, topical estrogen cream applied along the midline of fusion will usually induce separation within a few weeks. Prolonged steroid application is discouraged to avoid systemic effects. Surgical division or separation is rarely required and more likely to induce additional cicatrix. It is rarely required in older girls or if difficulties persist.

 

In vaginal agenesis, the labia, clitoris and urethral meatus are seen but no vaginal lumen is seen above the hymenal ring. It is only with congenital vaginal agenesis that dilations or neovagina would be indicated.

 

With separation of the labial adhesions as pictured below, the labia minora, hymenal ring and entrance into the vaginal are well seen.

 

 

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