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Hair tourniquet syndrome of the clitoris.

Sporadic reports have appeared in the literature that call attention to the strangulation of appendages by errant strands of human hair. The condition is called the hair tourniquet syndrome and typically involves the digits and genitalia of infants and children.’-6 Constrictive injuries of fingers and toes are more common, although strangulation of the penis and rarely the clitoris has also been reported. We describe a case of a hair tourniquet ensnaring the clitoris. Prompt recognition and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation. A 5-year-old girl presented to the emergency department with a chief complaint of vaginal pain. Examination revealed a swollen and tender clitoris. There was no history of trauma, vaginal discharge, allergy, insect bite or urinary tract infection. Diagnosis was nonspecific vaginal inflammation and the child was referred to the primary care physician for additional treatment. However, the genital swelling increased and vaginal bleeding developed during the next 24 hours. Irritative urinary symptoms of progressive frequency, dysuria and incontinence also began. The local physician encountered a tender bleeding clitoris with marked swelling of the labia minora. The patient was referred for pediatric urology consultation. She was examined under anesthesia because of anxiety and severe discomfort while awake. An engorged hemorrhagic clitoris and edema of the labia minora were noted (see figure). A single strand of the patient’s hair was wrapped around the clitoris and embedded in the edematous tissue just beneath the clitoral hood. The hair tourniquet partially amputated the right superficial margin of the clitoral body. The tourniquet was removed with a fine toothed forceps and scissors. Hyperemia of the clitoris developed immediately after its removal. Pain and voiding symptoms improved immediately, and swelling of the labia and clitoris resolved completely during the next 24 to 48 hours. The genitalia had an essentially normal prepubertal appearance on routine examination 1 week later.