title: Vaginal laceration from a high-pressure water jet in a prepubescent girl.
abstract: OBJECTIVE
  To document an unusual case of water douche injury in a prepubescent girl.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  After sitting atop a high-pressure water jet in a public fountain, a 9-year-old girl experienced pain and vaginal bleeding. She sustained a laceration high in her vaginal vault with an estimated total blood loss of 750 mL. Examination and vaginal packing were done under general anesthesia resulting in cessation of bleeding.
  
  
  CONCLUSIONS
  High-pressure water douche is recognized as producing serious vaginal injury in adult women but is not well reported as a cause of genital trauma in the pediatric population. Although not well documented, the prepubescent vagina is capable of receiving significant trauma due to highly pressurized water. Initial trauma management should be implemented with subsequent repair of the laceration, if possible. The prepubescent genital anatomy must be taken into account during examination and postoperative care.
authors.affiliation: Division of Pediatric Gynecology, Department of Obstetrics and Gynecology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. jalacy@stanford.edu
authors.forename: Judith
authors.initials: J
authors.lastname: Lacy
authors.forename: Erin
authors.initials: E
authors.lastname: Brennand
authors.forename: Melanie
authors.initials: M
authors.lastname: Ornstein
authors.forename: Lisa
authors.initials: L
authors.lastname: Allen
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000209:etiology* / Q000628:therapy*; D011312:Pressure; D018570:Risk Assessment; D013550:Swimming; D016896:Treatment Outcome; D014621:Vagina / Q000293:injuries*; D014867:Water
chemical_list: D014867:Water