Background Long term follow up of straddle injuries (SI) in prepubertal females is not well documented in current literature. It is unclear how these patients should be counseled about how prepubertal SI could affect pubertal development of genital structures. We present a case of post pubertal asymmetric right labial hypertrophy in a patient with prepubertal SI. Case Our patient initially presented at 8 years old (YO) to our emergency department (ED) after sustaining a SI from falling on a playground beam. Evaluation in the ED showed a hemostatic shallow right labial laceration at 9 o'clock. Repair was not indicated and she was discharged home. Follow up in the office 2 weeks later showed the area had healed well, no anatomic abnormalities noted. At 13 YO, she presented to the office for evaluation of abnormal right labia minora (LM), discovered after getting a hair tourniquet on the area. At her visit, she reported normal pubertal development and menarche at 12 YO. In addition to the hair tourniquet, she reported the area of abnormal tissue was causing discomfort, frequently catching on underwear and clothes. On physical exam, she was noted to have Tanner stage IV pubic hair. The bilateral labia majora were normal and symmetric. The left LM was normal in shape and appearance, and approximately 1 cm in length. The right LM was abnormal, having a pedunculated length of tissue measuring 6 cm in length and 1 cm in width, with the base of the LM extending from the clitoral hood to approximately 9 o'clock, below which there was no identifiable LM tissue. There was no visible scar in the area of her prior SI, however that was the location where the right LM tissue ended. The patient and her parents elected for surgical correction of the abnormal area. She underwent right labiaplasty, and the excess pedunculated right LM tissue was removed without complications. On post operative follow up, the area was well healed. Comments Most studies on prepubertal SI only include short term follow up, typically until healing of the injury has occurred. There is a paucity of data regarding long term outcomes. Though most SI are minor and will likely have no long term effect, our case demonstrates how even a seemingly minor prepubertal SI with no visible scarring in the area can lead to abnormal development of the genitalia with puberty.
