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Strangulated hair clitoral syndrome (SHCS) is an uncommon but clinically significant paediatric condition caused by a hair strand encircling the clitoral hood, leading to ischaemia and tissue necrosis. Recurrent episodes of SHCS cause repeated physical pain and place a significant psychological burden on the child, while simultaneously provoking significant anxiety among caregivers. We present a case of a prepubertal girl under 10 years of age with recurrent SHCS. While the initial episodes were managed conservatively, the final recurrence resulted in necrosis, requiring surgical debridement. Histopathology confirmed coagulative necrosis, a finding rarely documented in published literature. The case illustrates the anatomical susceptibility of hair tourniquet injuries among children, the difficulties of diagnosis and the value of early identification, parental education and effective management to avoid long-term consequences and recurrent injuries, while also underscoring the psychological distress experienced by both the child and family.