Unintentional Perineal Injury in Prepubescent Girls: A Multicenter, Prospective Report of 56 Girls

Abstract

Objective. To determine the pattern of perineal injuries and frequency of hymenal involvement resulting from unintentional trauma in prepubescent girls. Design. Prospective, multicenter. Observation by skilled observers. Determination of the circumstance and physical pattern of injury, with specific attention to the hymen. Setting. Children's emergency department or acute care clinic. Patients. Tanner stage 1 girls presenting with acute perineal injury. Criteria for unintentional injury: observation of the event or knowledge of the girl's engagement in a risky activity (eg, biking or climbing monkey bars) immediately before the injury. Results. Fifty-six girls were evaluated. Age range: 1 to 12 years (median, 6 years; mean, 6.2 years). Associations: bicycle, 39%; other outdoor injuries, 25% (climbing apparatus, straddling an object, and falls); indoor injuries, 36% (straddling furniture and falls). Most injuries were minor. In each group the labia minora was the most frequent structure involved. The majority of injuries were anterior or lateral to the hymen. However, in 34% some or all of the injuries were posterior to the hymen. Thigh injuries were observed only in older children engaged in bicycle riding or outdoor play. In only one patient was the hymen involved. That patient was a 2 year old who fell outdoors, at a park, abducting her legs in a splits-type mechanism. She had a pinpoint abraded area on the hymenal surface at three o'clock. Otherwise, no unique pattern of injury was associated with age or circumstance of injury. Conclusions. Hymenal injuries are rarely the result of unintentional injury. The presence of a hymenal injury should suggest sexual abuse. Involvement of other perineal structures was commonly associated with unintended injury. Given the limited resources for prevention, the relative infrequency of perineal injuries and the minor nature of most of these injuries, significant preventive efforts are not justified.