If you are one of those parents who only has male children, like me, you probably have not heard of synechiae in your life. If instead you have one or more daughters, perhaps in one of the reviews with the pediatrician or the nurse you have been told that “the girl has a minor lips synechia“.
This strange name is nothing more than the technical way of saying that the girl's small lips have adhered to each other, and that something must be done to take them off.
If in spite of having girls you have never heard it calm, it is because it does not happen to all girls, however, if your daughter is one of those who have suffered this inconvenience you may have to know that there is a lot of controversy when it comes to treating synechiae Because, while some professionals choose to separate them, sometimes doing enough harm to girls, others choose not to do anything.
Symptoms of the labia minora are relatively frequent
It's not that all girls suffer minor lip synechia, also called vulvar synechia, but it is relatively frequent. It is considered as one of the most frequent gynecological problems in girls before puberty and it is estimated that about 3.3% of girls between 13 and 23 months suffer from it.
The fact is that it seems that this number is increasing and the reason is the increasingly widespread use of wipes as the only method of vaginal cleansing. It is not that the synechia are produced by using wipes, because the cause is not entirely clear and seems to be associated with the low level of estrogens that girls have before puberty, but the fact of using wipes and not water means that secretions and remains do not leave the area (The wipe is clean, but it also drags and sometimes not enough), acting as a "glue."
They can be asymptomatic, or not
Most often, girls have no symptoms. In fact, as I said at the beginning, most parents realize that their daughters have adhesions because someone sees them and comments: "Did you know that your daughter has a vulvar synechia?" Answer: “What has what?
Some girls, however, may have some symptoms such as vaginal irritations or being a little more serious, vaginal infections or recurrent urinary infections. In more severe (and at the same time more rare) cases, symptoms such as incontinence or urinary retention may occur.
How vulvar synechiae are treated
As it is usually said “each teacher has his booklet”, which does not mean that all booklets are good, or that all are bad.
Perhaps parents who have had daughters with adhesions can tell how it was in your case, but here a server, to date, has only seen treating vulvar synechia manually, that is, separating the lips with a thermometer or pointed element Rome, previously applying (sometimes not) anesthetic cream.
Girls usually cry, and a lot. First because you hold your legs and we know that any maneuver that immobilizes a child will cause crying and, second, because it probably hurts a lot.
For a while, I decided to inform myself because it seemed impossible that this was the only way to treat something like that and, just as in phimosis it is recommended to wait, then wait and finally wait a little longer, I thought it could be logical too Wait if the girls had no symptoms.
So I found some studies and spoke with professionals who explained that the initial treatment is not to separate adhesions as good as possible, but apply an estrogen cream.
It is a treatment that has been proven effective, but that works worse when girls are 36 months old (that is, 3 years old) and when girls have dense or fibrous adhesions. As side effects of the cream, an increase in breast development and increased pigmentation of the vulva have been described, although they are symptoms that occur frequently and also disappear when the treatment is withdrawn.
The problem is that when the cream stops applying the adhesions can reappear, making new treatment cycles necessary or using more aggressive treatments such as manual separation or surgical separation.
And corticosteroid creams for vulvar synechiae?
Many professionals have also thought about the use of creams with corticosteroids to treat adhesions, as recommended in case of phimosis. The reality about this treatment is still unknown, because few studies have been done and are inconclusive.
In short, it is best to wait, as with phimosis
Estrogen cream treatment is effective, but adhesions may reappear. Manual or scalpel separation is a more aggressive, more stressful treatment for girls and, sometimes (seen by my own eyes), the synechia reoccurs.
Faced with this panorama, and knowing that Failure to treat girls does not pose a greater risk of later having symptoms (Current evidence tells us that you cannot say that "if we do not treat it now, then it will be worse"), what is recommended is that, If the girl has no symptoms, do nothing. The pediatrician should know the case and inform the parents of the symptoms they should monitor so that, in case of presenting, go again to perform the separation of the lips if necessary.
Manual or surgical separation, which, as I say, has been carried out for any "living" synechia should be reserved for the most severe cases or in case of significant symptoms (as with phimosis, let's go).
With respect to vulvar synechia in itself, many of them end up disappearing spontaneously, so knowing this we have one more reason to wait. While we wait we can, in addition to monitoring the possible appearance of symptoms, wash with water after diaper changes, because the water takes the dirt with it better than the wipes and, eliminating the “glue”, we decrease the chances of adhesion. It's not much, but it's something.
