January Week 4: Labial Adhesions/Imperforate Hymen


Common Gynecologic Problems in Prepubertal Girls – Peds in Review 2006


You are taking “mommy call” when your pager goes off at 2 am with a frantic first time mom. “Doctor, my 2 day old baby has milk coming out of her breast! Is this normal?”
1. What would you tell this mother?
2. What other anatomical information would you share with mom to avoid a repeat call tomorrow at 2 am?
A 14-year-old girl presents to your office for the first time. She was diagnosed with chronic constipation by her previous pediatrician. Mom is concerned because her daughter has had several months of intermittent abdominal pain, urinary retention, and constipation. She denies menarche. Mom states her first menstrual cycle was at age 12.
1. What would be your differential? 
2. If your suspicion is confirmed, what would be your next step?

A 30 month old girl presents to your clinic for a check-up. Mom stated she has had some difficulty with potty training and has frequent diaper rashes. On exam you notice a small labial adhesion that starts at the posterior introitus.
1. What advice on treatment would you offer at this time? 
2. What would you tell mom is the most likely cause of the adhesions.

Three months later mom returns because the labial adhesions are worse. On exam you note that the adhesions have progressed and partially obstruct the urethral orifice.
1. What would your recommend for treatment?
2. What instructions would you give mom along with the treatment?

When performing a genital examination on a child or toddler, what steps can you take as a pediatrician to make your patient as comfortable as possible prior to the exam?

Cases/Questions written by Dr. Edna Termilus