Treatment of Prepubertal Labial Adhesions with Topical Estriol + Testosterone: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors The authors presented the case of a 29-month-old girl with symptomatic labial adhesions who was initially treated unsuccessfully with topical estriol and then with a cream containing both estriol and testosterone and made a full recovery. This case has shown that both androgens and estrogens play a role in maintaining the physiological state of the vulva and vagina and that the use of both is the better choice in the treatment of labial adhesions.
This case report could be a step forward in the treatment of vulvar adhesions.

Minor sugestion:
1. Line 134,135..."This condition represents a common disorder in the female pediatric popu- lation with an estimated occurrence of 0.6–3.3% in prepubertal girls"
Can we say that it is a common disorder with this percentage of occurrence?

Author Response

Thank you for your revision.

-Line 134,135..."This condition represents a common disorder in the female pediatric popu- lation with an estimated occurrence of 0.6–3.3% in prepubertal girls"
Can we say that it is a common disorder with this percentage of occurrence?

Author response and action taken:

-We modified the sentence, as suggested by Reviewer

Reviewer 2 Report

Comments and Suggestions for Authors

Based on my review, a few potential shortcomings of this study on treating prepubertal labial adhesions include:

 

1. Only 43 girls were initially enrolled, with 38 completing the study. A larger sample would provide more statistical power.

 

2. The study does not appear to report long-term follow-up to assess recurrence rates or lasting effects of the treatments.

 

3. The study focused on prepubertal girls aged three months to 12 years. Including postpubertal adolescents could provide insights into treatment efficacy across a broader age spectrum.

 

4. The study only compared topical estrogen to a topical emollient. It did not evaluate other potential treatments like topical steroids or manual separation.

 

5. Using only an emollient as the control rather than a true placebo may impact the interpretation of results.

 

6. Both groups used lateral traction along with the topical treatments, which could confound the effects of the medications alone.

 

7. The study focused on clinical outcomes but did not report on the patients' and families' experiences or preferences.

 

8. As a single-center study, the results may not broadly apply to all populations or clinical settings.

 

9. The study did not evaluate the relative costs and benefits of the treatment options.

 

10. Comparisons across studies can be challenging Without a universally accepted system for grading labial adhesion severity.

 

These limitations suggest opportunities for future research to build upon this study's findings with larger, more comprehensive trials.

Comments on the Quality of English Language

minor

Author Response

Thank you for your revision.

Regarding your comments:

1. Only 43 girls were initially enrolled, with 38 completing the study. A larger sample would provide more statistical power.

       Author's response: Sorry but we don't understand, our paper is a case report

2. The study does not appear to report long-term follow-up to assess recurrence rates or lasting effects of the treatments.

        Author's response: we agree with Reviewer's suggestion, in fact we plan to performe a larger                 study with a longer follow-up

3. The study focused on prepubertal girls aged three months to 12 years. Including postpubertal adolescents could provide insights into treatment efficacy across a broader age spectrum.

         Author's response: Sorry but we don't understand, our paper is a case report

4. The study only compared topical estrogen to a topical emollient. It did not evaluate other potential treatments like topical steroids or manual separation.

        Author's response: Sorry but we don't understand, our paper is a case report

5. Using only an emollient as the control rather than a true placebo may impact the interpretation of results.

         Author's response: Sorry but we don't understand, our paper is a case report

6. Both groups used lateral traction along with the topical treatments, which could confound the effects of the medications alone.

         Author's response: Sorry but we don't understand, our paper is a case report

7. The study focused on clinical outcomes but did not report on the patients' and families' experiences or preferences.

         Author's response: the Reviewer's suggestion is pertinent, but we think that management of this relevant condition may not be linked to patients' and families' experiences or preferences rather a consistent letterature data

8. As a single-center study, the results may not broadly apply to all populations or clinical settings.

      Author's response: Sorry but we don't understand, our paper is a case report

9. The study did not evaluate the relative costs and benefits of the treatment options.

       Author's response: we proposed a novel and non expansive approach

These limitations suggest opportunities for future research to build upon this study's findings with larger, more comprehensive trials.