The vulva of the newborn exhibits the effects of residual maternal estrogen. Immediately after birth, the labia appear swollen, and a white mucoid discharge is present for the first few weeks of infancy. The discharge is normal and can be cleansed by wiping gently from front to back with a damp washcloth, moistened cotton wool, or wipe. As the influence of the residual maternal hormones declines, slight blood spotting may occur because of endometrial bleeding caused by maternal estrogen withdrawal. These effects cease within three to four weeks of birth once the influence of residual maternal estrogen dissipates fully.
Labial adhesions sometimes occur in late infancy and in the toddler years, most often between the ages of about two months and two years. This condition, related to estrogen deficiency, creates a flat vulvar appearance that may elicit parental anxiety. Labial adhesions are usually asymptomatic and outgrown without the need for treatment. Occasionally, urinary tract or vulvovaginitis symptoms result if there is blockage of the free flow of urine. In this event, topical estrogen is used to promote the separation of the labia.
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