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CASES

KEY QUESTIONS

  • What are some clinical scenarios that present with vaginal and vulvar trauma?

  • How should the initial evaluation of vaginal and vulvar trauma be approached?

  • What other considerations must be made when evaluating a patient experiencing vaginal or vulvar trauma?

  • What treatment options exist for vaginal and vulvar trauma?

  • What complications are associated with vaginal and vulvar trauma?

CASE 56-1

An 8-y.o. girl is brought to the emergency room by her parents after suffering a fall at school. She was playing on the monkey bars when she missed a bar and fell forward, straddling the rung of a ladder at the end of the bars. She did not hit her head. She began crying immediately. In the emergency room, she walks hunched over, unable to abduct her thighs. Blood is present on her pants at the crotch.

Her vital signs are as follows: axillary temp 37.4°C, blood pressure 99/59, pulse 110, and respiratory rate 22. Upon examination, the labia majora are erythematous bilaterally. The left side is significantly enlarged compared to the right, with purple ecchymosis and edema present. Upon palpation, the left labium majus is hard and tender. There is a superficial laceration at the inferior right labium majus that is hemostatic.

CASE 56-2

A 29-y.o. healthy female presents to the emergency room with heavy vaginal bleeding. She states that the bleeding began after sex with a new partner 4 hours ago and has continued since that time. She states that she has heavy bleeding, with clots, and has needed to change her tampon every 1–2 hours. Her last menstrual period was 1 week ago. She does not use any birth control. She states that this was consensual sex, and that no foreign objects were placed in her vagina. She has not had any nausea or vomiting, although she does feel lightheaded. She has never had an episode like this before. She denies any history of sexually transmitted infection or abnormal menses.

In the emergency room, she appears to be in no acute distress, but you note blood on her pants. Her vital signs are as follows: axillary temp 37.7°C, blood pressure 120/65, pulse 110, and respiratory rate 22. Upon examination, the external genitalia appear normal. She has blood and small clots in the vaginal vault. Her cervix appears normal, but there is persistent bleeding inferior to the cervix in the posterior fornix. No other lacerations are noted.

INTRODUCTION

In the wide range of trauma sustained by women and girls, perineal and vaginal traumas are relatively uncommon. In children age 0 to 16 years, the incidence was 8% of all traumas at Level 1 trauma centers. The mechanisms of injury vary based on age. Motor vehicle collision (MVC) was the most common cause of blunt trauma for children 0 to 16 years and ultimately made up 90% of all perineal and vaginal injuries for 15- to 16-year-olds....

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