Sir.—Practitioners need to remain alert to unusual causes of dysuria in their female patients. We have been trained to recognize vaginitis, vulvitis, gonorrheal infections, trigonitis, cystitis, and perineal irritation from pinworms or chemical agents. Too often, inadequate inspection of the vagina allows labial fusion to be overlooked. The following patients presented within one week in an active private practice in pediatrics.
Patient Reports.—Patient 1.—This 7-year-old girl was in good health until two days before her office visit, when she began to experience burning on urination, frequency, and dysuria. A urinalysis showed no nitrites or white blood cells. She had no previous urinary tract infections. On examination, the patient was noted to have fusion of the labia majora with a thin, translucent membrane. She was treated for one week with conjugated estrogen cream applied with a cotton swab. At a second visit, the membrane was still intact but