Unestrogenized tissues in prepubertal girls can lead to significant bleeding at the time of injury; however, spontaneous hemostasis is generally achieved by the time the medical evaluation is complete.
Children should never be forced into a genitourinary examination position. Having the child sit on a parent’s lap in a supine, frog-leg position can make the examination more comfortable for some children. Anxiolysis or procedural sedation may be required if the child is uncooperative.
Patients with genitourinary emergencies should be evaluated for evidence of urinary obstruction.
Traumatic genitoanal injuries can be classified using an injury severity score. (See Table 2.) Scores of II or greater may warrant specialty consultation.
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Kim K, No JH, Kim YB, et al. Patterns of accidental genital trauma and factors associated with surgical management in girls visiting the emergency department of a referral center. J Pediatr Adolesc Gynecol. 2014;27(3):133-137. (Retrospective study; 159 patients) DOI: http://dx.doi.org/10.1016/j.jpag.2013.09.005