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Clinical Summary

Genital injury can result from a fall (straddle) onto an object. A straddle injury usually causes damage to the external genitalia with unilateral bruising and swelling of labia and periurethral tissues. Occasional penetrating trauma to the hymen with internal injury can be seen. The history and the type of object involved are important historical elements. Obtain a detailed history from the child (if developmentally appropriate) separately from the accompanying parent/adult. Factors that increase concern of possible sexual abuse include no history of injury, injury in a nonambulatory child, vaginal or hymenal injury without history of penetrating trauma, history inconsistent with physical findings, and/or additional nongenital trauma.

FIGURE 15.106

Straddle Injury. This young child fell on to a pool edge sustaining a hematoma to the left labia majora (A, B). The remainder of her examination, including her hymen, was normal. (Photo contributor: Kathi L. Makoroff, MD.)

FIGURE 15.107

Straddle Injury. Bruising to the left labia majora and clitoral hood following a fall onto a bicycle bar. (Photo contributor: Cincinnati Children’s Hospital Medical Center.)

FIGURE 15.108

Straddle Injury. Ecchymosis, swelling, and contusion of the perineum in a 3-year-old female child who tripped and fell on a large plastic toy. (Photo contributor: James Mensching, MD.)

FIGURE 15.109

Toilet Seat Injuries. This toddler presented with a straightforward history of the toilet bowel falling onto his penis while voiding. He was able to void without difficulty. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 15.110

Toilet Seat Injuries. The toilet seat fell onto this toddler’s penis and caused bruising to the penis. Discharge is appropriate if the child can void without difficulty. (Photo contributor: Charles J. Schubert, MD.)

Acute bruising to the glans and corona of the penis can occur if the toilet seat falls onto the penis during voiding, trapping the penis between the seat and toilet bowl. This injury is not uncommon in boys of about 3 years of age whose height and development set the stage for this injury.

Management and Disposition

Check for urethral injury in children with straddle injuries. Treatment is usually symptomatic. Sitz baths and antibacterial ointment or barrier creams promote healing and minimize discomfort. If the child has difficulty voiding, encourage voiding in a bath with a few inches of warm water to reduce dysuria. If severe injuries occur, surgical repair may be necessary with consultation with pediatric gynecology ...

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