title: Genital and anal injuries requiring surgical repair in females less than 21 years of age.
abstract: OBJECTIVE
  The injuries of sexually abused and assaulted girls seldom require surgical repair, and genital and anal injuries due to other causes appear to require repair uncommonly. We sought to determine the causes of genital and anorectal injuries requiring surgical repair in relation to such variables as injury sites and severity.
  
  
  METHODS
  Retrospective study
  
  
  METHODS
  A large tertiary care children's hospital
  
  
  METHODS
  Forty-four girls less than 21 years of age who required surgical repair of genital injuries between June 1986 and April 2007 were identified.
  
  
  METHODS
  Information collected included the victims' ages, trauma mechanisms, and sites and severity of injuries.
  
  
  RESULTS
  Injuries requiring repair of the genital and anal areas were uncommon in the 20 year period of this study. Although most injuries were due to straddle and impalement mechanisms, sexual abuse or assault was identified in 25% of the girls. The remaining 11% were victims of motor vehicle accidents. Straddle/impalement injuries involved only the external genitalia, vestibule, perineum, or posterior fourchette of 21 of the 28 girls (76%) with those injuries. The injuries of 9 of the 11 sexually abused/assaulted girls (82%) also involved the hymen, vagina, anus, or rectum. Injuries due to sexual abuse/assault and motor vehicle accidents (MVA) had average severity scores of 2.1 and 2.2, respectively, while straddle injuries had an average severity score of 1.4. (Exact Pearson chi-square P < 0.003.) The ages of the girls were unrelated to the severity of their injuries.
  
  
  CONCLUSIONS
  Although straddle/impalement was the most commonly found mechanism of genital and anorectal injury requiring surgical repair, sexual abuse or assault was identified in 25% of the girls. Sexual abuse and assault should always be considered and assessed appropriately when such injuries are found. Consultation of a social worker or child abuse specialist may be appropriate, especially when injuries clearly not due to an MVA involve the vagina or anorectum. A suspicion of sexual abuse or assault should be reported to the legally mandated state agency in accordance with the laws of state.
authors.affiliation: Department of Pediatrics, University of Arkansas College of Medicine, Arkansas Children's Hospital, Little Rock, Arkansas, USA. jonesjerryg@uams.edu
authors.forename: Jerry G
authors.initials: JG
authors.lastname: Jones
authors.forename: Toss
authors.initials: T
authors.lastname: Worthington
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery; D001131:Arkansas / Q000453:epidemiology; D002648:Child; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data*; D005260:Female; D005835:Genitalia / Q000293:injuries* / Q000601:surgery; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D010502:Perineum / Q000293:injuries; D012189:Retrospective Studies