Labial adhesions are paper thin attachments between the inner walls of the opening of the vagina. These commonly occur in girls under a year of age. The skin of this part of the vagina occasionally becomes irritated from various causes including bubble bath, contact with urine or feces, or reasons we can't identify. But because of the close proximity of the labia to each other, when they heal, they sometimes become attached to each other.

Sometimes these adhesions may be able to be separated by gently pulling the labia apart. However, often they are quite soundly stuck together. In this latter case, applying estrogen cream (which softens these tissues) allows for these adhesions to be easily separated.

I agree that the adhesions your daughter has cannot be attributed to anything you have done or didn't do. However, I suggest you keep an eye out for anything that she comes in contact with that seems to irritate her diaper area so it may be avoided. Let me assure you that the use of estrogen cream for this use is, in fact, a conservative method. Because it is applied topically, there are essentially no side effects. Many adhesions resolve on their own when puberty occurs because estrogen naturally increases at that time. However, if the adhesions are extensive enough or cause problems with the urine stream, estrogen cream is a good way to go.

Your question about its approved use is an interesting one. Because testing is expensive and the concern for medical liability is large, many drug companies do not go through the FDA process to get drugs approved for children. In fact, there are many drugs used commonly in children which have not been approved for use in children. Examples include:

• Albuterol, the most common drug used for asthma
• Many antibiotics
• Griseofulvin, a common drug used to treat ringworm
• Several eye drops often used for "pink eye"
• Tegretol, used for treating seizures

Just to name a few.

As pediatricians, we are caught in a bind of wanting to allow children the benefits of breakthroughs in medicine without exposing them to potential dangers. Unfortunately, we sometimes don't get a lot of help from the pharmaceutical industry in this regard. Therefore, by looking at the experience with a particular drug in the adult population as well as looking at studies and other people's experience (e.g in Europe), medications are frequently given to children without formal FDA approval.

Premarin cream is another medication not FDA approved for use in children, but its use is common in treating labial adhesions. Adhesions are usually gone within the first few weeks of use.