Vulval Trauma in Children


52
Vulval Trauma in Children


Fiona M. Lewis


Traumatic injuries affecting the vulva are more common in children than adults. Accidental injury involving the genitalia is more common in girls [1], and the majority occur at home. In any child presenting with an injury to the genital area, the possibility of child abuse must be considered. It can be difficult to distinguish accidental and non‐accidental injury, and the two can occur together. Appropriate action and referral to paediatricians and safeguarding teams is mandatory if there are any concerns about this.


Non‐thermal vulval trauma


In prepubertal children, the hymen is thin and easily torn due to the low oestrogen state. The introitus and vaginal walls may therefore be involved in tears of the vulva after blunt trauma due to the fragility and relative lack of distensibility of the structures.


Causes


Unintentional injury can be due to pressure or crush damage as in the common straddle injury but also sharp penetrating injury and bites [2,3]. The majority of accidental injuries in children are falls in a straddle position often involving a gymnastic bar or bicycle. In a case series, 70% of genital injuries in children were straddle injuries, 23.5% blunt injuries, and only 6% penetrating injuries [4]. Skating accidents in can result in deep fissures of the perineum due to rapid adduction of the thighs [5], but penetrative injury is also described in this sport [6]. Rope swing injury can lead to laceration and avulsion of the labia with haematoma formation [7]. Vaginal injury from insufflation in water sports is also described [8]. Rarely, there may be tears of the fourchette in the neonate after breech delivery [9].


Although not an acute injury, prolonged cycling can result in oedema of the labia majora, often unilateral, and has mainly been described in adults (see Chapter 54). One case is reported in an adolescent [10]. See Table 52.1.


Clinical features


The labia majora and minora are most commonly involved as the soft tissue is compressed against the pubic symphysis and rami. There is swelling and bruising and haematoma formation if severe. The hymen and posterior fourchette are rarely involved in straddle injury, but deep posterior fissures can result after rapid adduction injury. In penetrating injuries, laceration and abrasions are usually evident, as well as bruising.


Table 52.1 Causes of accidental vulval trauma in children.
























Type of injury Mechanism Major causes
Straddle Blunt trauma with compression Bicycling, gymnastic bars
Adduction Rapid adduction tearing posterior fourchette Skating
Insufflation Rapid introduction of water into vagina Water sports
Penetrating Sharp penetrating injury Road traffic accidents, knife wounds

Differential diagnosis


The diagnosis is usually obvious as there will be a history of trauma. However, acute genital ulceration associated with infection will develop rapidly (see Chapter 19).The ecchymosis seen with lichen sclerosus can be mistaken for trauma, but the other features of this dermatosis should be clear. Hymenal injuries are rarely the result of unintentional injury and should always raise the possibility of sexual abuse.


Complications


These include infection, haematoma formation, and scarring.

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Nov 10, 2022 | Posted by in GYNECOLOGY | Comments Off on Vulval Trauma in Children
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