II. Precautions
- Observe for signs of pediatric sexual abuse and Nonaccidental Trauma
- However, Most cases will be accidental
- Accidental straddle injury causes
- Bike accidents or straddle injuries
- Bed frames
- Playground equipment
- Bathtub fixtures
III. Management: Blunt injury (most cases)
- Superficial Skin Tearing or Contusion (e.g. vulvar Hematoma)
- Most common site occurs at the fossa between labial majora and labia minora
- Local bleeding may occur from site
- Perform gentle hygiene with clear water sitz baths multiple times daily for several days
- Ice or cool pack to the area up to 20 min/hour
- Analgesics as needed
- Frequently empty Bladder
- If Dysuria, child may urinate in the sitz bath
- Small vulvar Lacerations (<3 cm) without bleeding
- Suturing is NOT required
- Apply topical Emollient (e.g. aquaphor or Bacitracin) to the area several times daily until healed
- Deep Lacerations (esp. involving clitoris, Urethra, labia minora, vaginal introitus, posterior fourchette)
- Consider pediatric gynecology or pediatric surgery for better functional and cosmetic closure
IV. Management: Sharp injury (uncommon)
- Higher risk for deeper penetrating injury
- Consult pediatric gynecology or surgery if signs penetrating injury (esp. blood from introitus)
- Urgent vaginal endoscopy may be indicated
V. References
- Claudius and Willner in Herbert (2019) EM:Rap 19(1): 2-4
- Rucker (2025) Crit Dec Emerg Med 39(9): 4-12