++
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.
++++++++++++
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 or surgery.
++
No specific treatment is needed ...