RECURRENT LABIAL ADHESIONS AT GIRLS : NEW ASPECTS OF AN OLD PROBLEM

WWW.REPRODUCT-ENDO.COM.UA No5 (19) / ноябрь 2014 ISSN 2309­4117 9 Y.G. ANTYPKIN academician of the NAMS of Ukraine, MD, professor, Honored Scientist of Ukraine, Laureate of the State Prize of Ukraine in Science and Technology, Director of the Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine T.F. TATARCHUK MD, professor, corresponding member of the NAMS of Ukraine, Deputy Director for Research Work, Chief of the Endocrine Gynecology Department, Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine N.K. SILINA PhD, senior researcher, Department of Medical and Psychosocial Health Problems of the Family, Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine M.Y. SERGIENKO PhD, associate professor, Obstetrics and Gynecology Department, Faculty of Postgraduate Education of the Donetsk National Medical University named after Maxim Gorky E. TCHAIKIVSKA PhD, assistant professor of the Obstetrics, Gynecology and Perinatology Department, Lviv National Medical University O.N. ZAYCHENKO MD, Head of the Department of Pediatric Urogynecology, Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine I.V. GNATUSHOK obstetrician-gynecologist,Medical center «Dobrobut» O.V. BACHYNSKA Pediatric and Adolescent Gynecology Department, National Children’s Specialized Hospital «Okhmatdet» I.V. GAVRILOVA Head of the Pediatric and Adolescent Gynecology Department, National Children’s Specialized Hospital «Okhmatdet» INTRODUCTION Problem of recurrent labial adhesions at girls under the age of 8 years is gaining more and more relevance [1]. The lack of offi cial statis­ tics on the incidence of this pathology led to a lack of clinical supervision in this category of patients. In turn, the short time observation of girls after surgical or conservative treatment gives the offi cial low reccurence rate, only 11– 14%. Infl ammatory process of external genitalia at girls can be a good background for the future disorders of the reproductive health of young women [2].


INTRODUCTION
Problem of recurrent labial adhesions at girls under the age of 8 years is gaining more and more relevance [1].The lack of offi cial statis tics on the incidence of this pathology led to a lack of clinical supervision in this category of patients.In turn, the short time observation of girls after surgical or conservative treatment gives the offi cial low reccurence rate, only 11-14%.Infl ammatory process of external genitalia at girls can be a good background for the future disorders of the reproductive health of young women [2].

ANALYSIS OF PUBLISHED DATA AND THE FORMULATION OF RESEARCH PROBLEMS
According to The Royal Children`s Hospital Melbourne, manual separation of adhesions accompanied by high traumatization of girls emotional sphere and subsequent high risk of recurrence, and the use of creams con taining estrogen is also associated with a high risk of relapse [3].In the United States Center Disease Control conducts regular ep idemiological studies which are based on a questtionnare survey of parents in order to find out real digits of the incidence of chil dren diseases [4].
High rates of adhesions in girls up to 8 years old, not fully established etiological factors in their development, as well as the conflicting opinions about the diagnostic and therapeu tic approaches in the management of chil dren with adhesive process of vulva, caused the relevance of the present study.The aim of the research work «to find the consequences of disturbance of hygiene at girls in the fami ly, taking into account the social and region al particularities» is to determine the distur bance of the rules of personal hygiene as one of the main factors leading to adhesive pro cesses of the vulva, define the real percent age of the reccurence of the labial adhesions and develop the concept of prevention of this disease.
The object of study -level of knowledge about the intimate hygiene of the child at mothers of girls with recurrent labial adhe sions.
The total number of patients was 463 moth ers from the central (Kiyv), Western (Lviv), East ern (Donetsk) regions of Ukraine.The criteria for inclusion to the study were 290 (basic or main study group) mothers of girls aged 2 to 8 years, with recurrent adhesions of the labia minora (2 or more).The control group included -173 mothers who have healthy girls (age 8 years) without history of adhesions.Mom signed an informed consent form.All mothersparticipants were given the opportunity to answer questions by themselves in private and in an atmosphere of complete comfort.
We divided questions into several blocks: 1 set of questions was devoted to the moms interest to the questions of personal hygiene and weather they understand the importance of the subject; and to determine what information mothers have and weather this information is ad equate; separately, we asked about the source of the information at moms of control and basic groups; second block of questions was asked in order to fi nd out what mothers fulfi ll indeed.
Questions are presented in the tables 1-3.

RESULTS OF THE STUDY AND DISCUSSION
After analyzing the responses of the fi rst unit of questions, we identifi ed the following charac teristics (Table 1 the amount of mothers of the control group who change underwear at girls every day and not only when underwear gets dirty is more on 20% than in the main study group; it has been found that the percentage of reccurence of labial adhesions in 3 months was almost 40%, in 6 months -25% and in the year reaches 10%, there wasn't any signifi cant diff erences in relapses in three regions. One of the goals of our study was to determine the real per centage of recurrence of labial adhesions and period when it happens after treatment.The lowest percentage of recurrence is at girls with adhesions, who never had vulvitis -33,92% in three months and 23,8% in 6 months and 7,73% in a year.The highest percentage of the recurrence (45,29%) of labial adhesions was at girls with adhesions and vulvitis in anam nesis.In 6 months the percentage of recurrence at girls with adhesions and vulvitis in anamnesis was 26,49% and in a year 8,54%.Besides, we analyzed the percentage of reccurence at girls (the main study group) whose moms got information of intimate hygiene from pediatrician.This group had the high est amounts of recurrence of labial adhesions -57,57% in 6 months.
We had found out interesting fact that the informa tion about the rules of personal hygiene mom of girls of the study group received in significantly more cases from pediatricians.Number of mothers from the control group who received information about the hygiene of the girls from the books was in three times higher than in the study group (Table 2).
We analyzed the responses to questions of the 2 block of the main study group of mothers who have received informa tion from a pediatrician.
Only 21% of women use a separate towel for personal hygiene for her daughter.The question «how often should I change underwear» moms who have learned about the intimate hygiene from pediatricians responded that every day only in 63% of all cases.About 75% of these women wash their children after the act of defecation and only 63% change a diaper every 2-3 hours.Also in this group, about 40% use wet wipes for personal hygiene and not more than 20% -baby powder.However, 100% of women reported that their daughters have an individual soap and towel.This information may testify on two fundamental ques tions.There should be close cooperation work between pediatrician and OB&GYN in questions of girls care.But more likely, pediatricians in the structure of total admissions be cause of lack of time , time do not pay attention to the prob lem of personal hygiene and as a result of that, mothers also don`t pay much attention to that information.
After analyzing the second set of questions, we found the following facts in the study groups (Table 3): mothers who have used baby powder and baby liqued wipes for intimate hygiene were twice time more in the con trol group; the mothers from both groups almost in the same percent age of cases, wash their child after defecation, use individual soap and do not routinely use disinfectants and antiseptics for the intimate hygiene.
In addition, we found that mothers of girls with recurrent adhesions only in 25% of the cases use a separate towel for intimate hygiene for their daughters.

CONCLUSION
Thus, after data processing about the quality of wom en's knowledge about intimate hygiene, where do they get this information and how this knowledge is being im plemented in practice, we have made the following con clusions: 1. Violation of the rules of intimate hygiene at girls plays defi nite role in the development of labial adhesions and can be a risk factor for reccurence of labial adhesions.
2. The level of knowledge of mother about the rules of girl intimate hygiene is one of the most important factors in the prevention of disorders of reproductive health at girls.
3. Educative work of pediatrician and child gynecologist may have a decisive role in reducing the occurrence of relapse of adhesions of the labia minora in girls.
4. The highest percentage of relapses occurs within 3 months after treatment -up to 45%.
5. Longterm followup (not less than 1 year after the treat ment) of the girl with every 3months visit to the doctor should be implemented to the daily work of pediatricians and child gynecologysts.

TABLE 1 .
BLOCK OF QUESTIONS ON THE ISSUE OF MOTHERS INTEREST TO INTIMATE HYGIENE AND THEIR KNOWLEDGE ABOUT THE PROBLEM group than in the main study group; mothers of healthy girls know periods of girls development on 20% cases more than mothers of girls with labial adhesions; RECURRENT LABIAL ADHESIONS AT GIRLS: NEW ASPECTS OF AN OLD PROBLEM №5 (19) / ноябрь 2014 W W W.REPRODUCT-ENDO.COM.UA ISSN 23094117

TABLE 2 .
SOURCE OF INFORMATION MOTHERS CONTROL AND BASIC GROUPS

TABLE 3 .
UNIT OF QUESTIONS DESIGNED TO FIND OUT WHAT THE MOTHER FULFILLS INDEED