Diagnosing and Managing Common Genital Emergencies in Pediatric Girls

Points and Pearls Excerpt

• 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.

Most Important References

• Jacobs AM, Alderman EM. Gynecologic examination of the prepubertal girl. Pediatr Rev. 2014;35(3):97-104. (Review article) DOI: http://dx.doi.org/10.1542/pir.35-3-97
• Onen A, Ozturk H, Yayla M, et al. Genital trauma in chil-dren: classification and management. Urology. 2005;65(5):986- 990. (Retrospective review; 116 patients) DOI: http://dx.doi.org/10.1016/j.urology.2005.01.018
• Dane C, Dane B, Erginbas M, et al. Imperforate hymen-a rare cause of abdominal pain: two cases and review of the literature. J Pediatr Adolesc Gynecol. 2007;20(4):245-247. (Case report, review article) DOI: http://dx.doi.org/10.1016/j.jpag.2006.12.003
• 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
• Grisoni ER, Hahn E, Marsh E, et al. Pediatric perineal impalement injuries. J Pediatr Surg. 2000;35(5):702-704. (Case reports, review) DOI: http://dx.doi.org/10.1053/jpsu.2000.6011