38. Painless Labia Hair Tourniquet Presenting as a Recurrent Vulvar Mass

Abstract

Background Hair tourniquets are a rare phenomenon effecting potentially any appendage. Male genitalia and digits are the most common locations with female genitalia classified as an “other” site, occurring in less than 6% of reported reviews. The most recent review of female genital hair tourniquets identified 34 patients from 32 reports or series. Pain was reported as a presenting symptom in 30 cases, while the remaining four cases did not comment on pain. We present a case of an asymptomatic labial hair tourniquet presenting as a vulvar mass. Case The patient is a 5-year 7-month female born at 24 weeks gestation with intraventricular hemorrhage and subsequent cerebral palsy (CP) and lower extremity contractures. The patient was referred by her PCP for possible biopsy due to a recurrent vulvar mass that waxed and waned in size and purple discoloration over two months. The patient was scheduled for exam under anesthesia and noted to have an edematous left labia minora (Fig 1) with tightly wound hair and cotton threads at the base leaving an erosion with an indentation flap in its mid portion (Fig 2). The fibers were released, a ‘V” excision was created removing the mid portion (Fig3), and the inferior and superior areas of the labia were approximated restoring symmetry. (Figs 4) The patient s postoperative course was uncomplicated and at 20 months post procedure her parents report normal anatomy without new incidents of labia edema. Comments This case report demonstrates a presentation of chronic painless swelling due to a labia hair tourniquet, which has not yet been described in the literature. Absence of pain may have led to a delay in referral for definitive diagnosis and treatment. It is possible that sensory disruptions in the lower extremities from CP contributed to the lack pain perception by the patient.