TemplateLabial adhesionsTap a choice or type a Repertoire Line to see how the note changes. Defaults are what the template inserts on its own.Try a Repertoire Linelabial adhesionslabial adhesion: dribbling, estrogen, recheck adhesionlabial adhesions: improving, observe, 3 monthslabial fusion: irritation, betamethasonelabial adhesions: with utilabial adhesions: nearly complete, larger, urology referralPractice wording only: leave out patient details. Nothing typed here is saved or sent. Practice a case insteadMonthChoose anyFirst lineMonth and yearDefaultStatusChoose oneFirst lineNew finding on exam.DefaultImproving since the last visit.Unchanged since the last visit.Resolved.Larger since the last visit.ExtentChoose onePartial labial adhesion with the urethral opening visibleDefaultNearly complete labial adhesion with the urethral opening not visibleSymptoms presentChoose anydribbling after urinationurinary infectionsirritation or paintrouble passing urineSymptoms absentChoose anydribbling after urinationDefaulturinary infectionsDefaultirritation or painDefaulttrouble passing urineDefaultUrinalysisChoose oneUA negativeUA and urine culture sentTreatment decisionChoose oneObservation, since most adhesions separate on their ownDefaultStarted Estrogen cream to the line of fusionStarted Betamethasone cream to the line of fusionReferred to pediatric urology for separationReferred to pediatric gynecology for separationCareChoose anyDiscussed gentle vulvar care with plain water baths and a barrier ointment such as vaseline along the edgesDefaultFollow-upChoose oneat the next well child checkDefaultin 1 monthin 3 monthsafter the specialist visitas neededFollow-up reasonChoose anyJoins the line aboverecheck the adhesionCounseling paragraphChoose oneParagraphLabial adhesions are common in young girls, usually cause no problems, and often separate on their own, especially as hormones rise before puberty, though they can come back until then. Recommended supportive care with an emphasis on plain water baths, gentle drying, and a barrier ointment along the edges. Return precautions given including trouble urinating, dribbling, pain with urination, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.DefaultThe cream is applied with gentle pressure along the thin line where the labia meet until they separate, usually over several weeks. Temporary breast budding, darker skin, or light vaginal spotting can happen and go away after stopping, and the area may look bruised as it opens. Adhesions can come back, so a barrier ointment along the edges is continued for several weeks after separation. Return precautions given including trouble urinating, dribbling, pain with urination, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.The cream is applied with gentle pressure along the thin line where the labia meet until they separate, usually over several weeks, and the area may look bruised as it opens. Adhesions can come back, so a barrier ointment along the edges is continued for several weeks after separation. Return precautions given including trouble urinating, dribbling, pain with urination, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.The specialist can separate the adhesion and discuss how to keep it from coming back. Recommended supportive care with an emphasis on plain water baths and a barrier ointment along the edges until the visit. Return precautions given including trouble urinating, dribbling, pain with urination, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.What the sources coverExtent partial or nearly completeDribbling, UTI, irritation, trouble urinating present or absentEstrogen or betamethasone creamUrology or gynecology referralGentle vulvar care, barrier ointmentEstrogen side effects, bruised look, re-adhesion preventionReturn precautions in the templatetrouble urinatingdribblingpain with urinationfeverSourcesPediatric Care Online: Labial AdhesionsHealthyChildren.org: Labial AdhesionsAAP NewsFew formal guidelines cover this topic, so the template also leans on expert opinion.