The labial adhesions (also called labial agglutination and synechia vulvae) can be partial, involving only the upper or lower labia, or complete. The etiology and frequency are unknown. Labial adhesions may be asymptomatic or cause a pulling sensation, difficulty with urination, recurrent urinary tract infections, or recurrent vaginal infections. Management options range from reassurance for asymptomatic patients to manual or surgical treatment severe cases and cases resistant to conservative treatment. Controversy exists on whether treatment is indicated in asymptomatic cases, because the adhesions may resolve when estrogen production increases at puberty. Topical treatment with estrogen creams is effective in most patients and can be used safely to treat symptomatic prepubertal girls with labial adhesions. Treatment consists of topical estrogen cream applied once or twice daily at the point of midline fusion where there is a thin white line. Therapy may be required for several weeks to achieve separation of the labia minora. Breast bud formation is a possible side effect, which will resolve after the cessation of the topical estrogen cream. Failure of medical therapy tends to occur with thick adhesions with no thin translucent raphe. Surgical intervention for labial adhesion is reserved for rare patients with complete obstruction of urine flow in whom estrogen cream cannot be applied for psychosocial reasons or has been unsuccessful after an adequate trial. When necessary, surgical separation is performed with sedation and/or anesthesia and followed by topical estrogen cream for one to two weeks and then application of a bland emollient for 6to 12 months.