In this section
Acute Scrotal Pain or Swelling
Although most straddle injuries are minor, genital injuries in children often cause great anxiety because of the location and concern for future gynaecological and sexual development. The unoestrogenised pre-pubertal female genital tissues are friable (with excellent blood flow) and lack distensibility. Therefore, even minor trauma can cause injury and bleeding which may appear extensive.
Urogenital trauma frequently raises the question of non-accidental injury, however it is uncommonly associated with it. It is important to be able to correlate the history of the injury with physical findings on examination. Thorough documentation and appropriate referral of cases suspicious for abuse is a priority of care.
General assessment of the child looking for evidence of other injuries.
Examination should be performed only ONCE, therefore consider early involvement of a senior clinician. If suspicious of non-accidental injury contact the local forensic paediatric medical service.
Examination is usually performed in the supine frog-legged position. Explanation and gentle handling of the child is important. Consider analgesia +/- procedural sedation.
Document a detailed description of the injury. A clock face can often be used to describe the location of the injury (see diagram below).
Severity of Injury
Follow up / Consultation
Bleeding is minor or has stopped and the child can void spontaneously
Salt water baths for comfort
Topical anaesthetic cream or barrier cream to reduce local pain on micturation
Reduction in strenuous activity for 24 hours to prevent re-injury
Ongoing bleeding, laceration borders not visualised, labia minora tear, unable to void, clinician concern
Management as above
Consider urethral catheter if unable to void e.g. in the presence of a large vulval hematoma
Local paediatric team
Local Gynaecology or Surgical service
Child requiring care beyond the comfort level of the local hospital
For emergency advice and paediatric or neonatal ICU transfers information, see Retrieval Services
Minor injury and able to pass urine
NSW The Child Protection Helpline 132 111
Child Protection Units:
Queensland’s Child Protection and Forensic Medical Service
07 3068 2659 or 07 3068 2660 / AH 07 3068 1111
Victorian Forensic Paediatric Medical Service (VFPMS) 1300 66 11 42
Last Updated May 2020