Trauma to the External Genitals 3 (Genital Bleeding)

gebl_11a_n.jpg, gebl_11b_n.jpg, and gebl_11c_n.jpg, gebl_11d_n.jpg: 4.2-year-old girl after a fall on the buttocks. gebl_11a_n.jpg, gebl_11b_n.jpg: Examinations in the emergency department. On inspection without and with spreading of the vulva a swelling and bluish-red discoloration of the foreskin of the clitoris is visible; the frenulum does not continue in the labium minus on the left side; there is a clot underneath the labium minus, and striking pallor of the skin. gebl_11c_n.jpg, gebl_11d_n.jpg: Examination in general anesthesia in lithotomy position on the operating table. Perineum and anus are intact. A catheter lies in the vagina. There is a severe swelling of the clitoris and its foreskin ( gebl_11c_n.jpg). Avulsion of the frenulum and the labium minus on the left side with soft tissue hemorrhage !£gebl_11c_p£! ( gebl_11d_n.jpg) and intact urethra. gebl_11a_n.jpg to gebl_11d_n.jpg: There is a substantial loss of blood. The left frenulum and labium minus is totally detached from the base, and there is a severe contusion of the inner side of the left vulva. This sequence of pictures illustrates the requirement of examination and surgery in general anesthesia, and in the operating theater for several reasons including psychological arguments. For touching the wound, gloves should be worn.