Accidental Trauma

The most common mode of accidental genital trauma in females is a straddle injury. These injuries may involve the vulva, labia, clitoris, vagina, and adjacent urogenital and anogenital structures. Genital injuries may result in minor lacerations and bruising that heal rapidly, or profuse bleeding may occur in the setting of severe injuries requiring surgical repair. The clinician must assess whether the history provided is compatible with the injuries found on physical exam; inconsistencies should raise suspicion of intentionally inflicted injuries or sexual abuse. The physical exam may be performed with or without anesthesia, depending on the ability of the child to cooperate and the extent of the injury. Vulvar hematomas are painful and may cause urinary retention due to pain and swelling. Evacuating very large or expanding hematomas may reduce pain and hasten recovery. Healing is usually complete without residual defect or long-term adverse effects.