For vulvar contusions, cold packs often suffice.(Gynecology)

NEW YORK -- A vulvar injury in a child is likely to heal without major intervention, even if a large hematoma is present and the patient complains of severe pain, David Muram, M.D., said at a gynecology conference sponsored by Mount Sinai School of Medicine.

Typical vulvar injuries are accidental deceleration injuries, occurring when the child falls on the crossbar of a bicycle or while climbing fences or playground equipment. The vagina, urethra, and hymen are usually spared because of the protection provided by the over-lying labia, Dr. Muram said.

If there is no evidence of hymeneal injury--which is unlikely to result from an accident--the main concern is ensuring the child can void. If not, she should be kept for observation, and a suprapubic catheter should be placed, he said.

It's also a good idea to check whether there is a fracture of the pubic bone. "Tell her to stand up and raise one foot at a time. If this causes pain, get an x-ray. Not that you are going to do anything about it, but you won't be ...