In this section
Scrotal Pain or Swelling
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
and therefore, even minor trauma can cause injury and bleeding which may appear
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
Red flag features in
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).
Features to consider on examination:
General principles of care
If suspicious of non-accidental injury contact the local forensic paediatric medical service.
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 service
Children with non-minor injuries
Child unable to pass urine
Child requiring care beyond the comfort level of the hospital
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Parent information sheet: link to handout
Victorian Forensic Paediatric Medical Service (VFPMS)
1300 66 11 42
Discuss non-minor injuries with Gynaecology
Last Updated January 2019