A 10-year-old female is brought to the emergency room by her grandparents after sustaining an unwitnessed fall while on the playground. The patient reports having been swinging on the monkey bars, slipping on the edge of the landing, and ultimately straddling the handrail of the landing. She had immediate onset of pain and was able to walk to her grandmother and describe her fall. They went to the bathroom to assess her injury and noted blood in her undergarments, prompting them to come immediately to the emergency room. She remains in pain currently. She and her grandmother report heavy bleeding from the injury. Prior to this event the child was in her usual health. She has not yet had menarche, though they have noted some breast development. She has not had prior genital trauma or vaginal bleeding. She has been in her grandparents’ custody for the last six months.