Genital trauma

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Genital trauma is trauma to the genitalia.

History of studying genital trauma

Doctors and nurses have been conducting sexual assault examinations and have been collecting evidence for victims of assault for 20 years. But the amount of scientific data collected on genital injuries post-sexual assault are still minimal. Therefore, there is no available evidence to show specific patterns of injury resulting from sexual assault. [1] The motivation for investigating and collecting data on genital injuries has primarily been within the context of the legal system, such as proving or disproving sexual assault, rather than for medical purposes. The studies that have been done in the past 25 years in relation to sexual assault cases in the judicial system has laid the groundwork for interpreting sexual assault injuries. It is important for there to research on genital injuries more broadly relating to sexual activity (and not just sexual assault) to improve medical knowledge on the subject. [1] Methods of studying and documenting genital injury has greatly improved through the use of tissue staining dyes and colposcopy. The first studies that used newer methods were retrospective chart reviews done in a hospital by a doctor or nurse. These studies used several different methods to identify and document injuries, such as direct visualization, colposcopy, and/or tissue staining dyes. Earlier studies only used direct visualization for their data. [1]

Contents

Vaginal trauma from consensual and non-consensual intercourse

Vaginal trauma is possible during and after consensual and non-consensual intercourse so it is difficult to determine the circumstances in which the trauma occurs only based on a physical examination. It can be difficult to differentiate between injuries from consensual sex and injuries from sexual assault in adolescents. [2] Women are three times more likely to have vaginal injuries and intercourse-related injuries from a forced assault than from a consensual sexual experience. [3] Vaginal lacerations that happen during consensual or non consensual intercourse might need surgery, but victims of a forced assault will need additional services such as police intervention and trauma counseling. [2] There is little research on minor injuries in adult, pre-menopausal women, adolescent girls, and post-menopausal women that do not require surgery or treatment. [4]

Why does vaginal trauma occur?

There are factors that can predispose women to vaginal injury during consensual sex. These things include: first sexual experience, pregnancy, vigorous penetration, vaginal atrophy and spasm, previous operation or radiation therapy, disproportionate genitalia, penile ornamentation, and congenital anomalies. [5] During vaginal intercourse in the missionary position with legs tilted all the way back, the penis reaches its deepest penetration and the extreme rotation of the uterus leads to hyper distention of the vaginal wall, which in some cases can cause it to rupture. This position is the most likely position for vaginal laceration. The vaginal wall on the right side is the most commonly torn site in this position. [3] Vaginal lengthening and lubrication usually occurs naturally in a consensual sexual situation. Vaginal tearing can occur in rape victims because those two things will not occur. This is consistent with the fact that more injuries result from sexual assault than from consensual intercourse. [3] An inability to produce adequate vaginal lubrication and dilatation is thought to be an underlying cause of severe tears in the upper area of the vagina. [2]

Types of vaginal trauma

Intercourse-related lacerations can range from superficial tears to more severe lacerations, tears rarely extend into the rectal lumen and the peritoneal cavity. Recto-vaginal injuries are usually a result of assault with a foreign object, rape, or accidental gynecologic injury. Injuries of this severity that resulted from consensual sex are very rare. [5] Posterior and right vaginal fornix lacerations have been known to occur during consensual vaginal intercourse. The location of these lacerations is usually based on a woman's reproductive anatomy. It is common for women to have a uterus that lies slightly to the right, this exposes the right fornix and makes it easier for some type of tearing or trauma to occur. [2] Lacerations to the posterior peri-cervical vagina tend to occur in the missionary position, hips and legs hyperflexed. Other positions can also expose the posterior vaginal wall that usually protected by the cervix, this allows for posterior fornix tears. Tears in the upper area of the vagina are more often reported in consensual intercourse than forced intercourse. Complications from severe vaginal lacerations, such as from an assault, can include hemoperitoneum, pneumoperitoneum, and retroperitoneal hematoma with or without vaginal perforation. Tears along the long axis of the vagina or the posterior fourchette lacerations are more likely to occur from rape. Lacerations or tears of the hymen are common but are not indicative of consensual or non-consensual intercourse. [2]

Treatment of vaginal trauma

Diagnosing and treating vaginal trauma can often be difficult and delayed due to the sensitive and personal nature of these types of injuries; this also may be enhanced if the patient is young in age. [2] The repair of most genital injuries require suture and the bleeding from the area is usually minimal. [3] The bleeding that results from extreme vaginal tears can be copious, leading to hemorrhagic shock, and the patient may need a blood transfusion. Treatment of these lacerations could warrant surgical repair. [2]

Vulvar trauma

Vulvar trauma is more common in prepubertal children due to small labial fat pads and more physical activity. Adults are more protected. Though some injuries are serious, most are accidental minor blunt traumas. The most common type of injury is a straddle injury, which can be incurred through normal activities like bicycle riding. Due to the vascularity of the vulva, it may form a large hematoma when injured. The vulva can also be injured through sexual assault. Vulvar trauma can occur concurrently with vaginal trauma, especially if a sharp object is involved. [6]

Vaginal trauma

Vaginal trauma can occur when something is inserted into the vagina, for example, a sharp object, causing penetrating trauma. [6] Vaginal trauma can occur as a result as an initial painful sexual experience or sexual abuse. [7] Vaginal trauma can occur in children as a result of a straddle injury. Most of these, though distressing, are not serious injuries. In some instances a severe injury occurs and requires immediate medical attention especially if the bleeding will not stop. [8] [9] Vaginal trauma occurs during an episiotomy. [10]

Penile trauma

Penile trauma can take several forms. Abrasions can be caused by a zipper injury, and fractures can be caused by sexual activity. [11] One type of penile trauma is penile amputation. Penile amputation is a rare injury and is considered an emergency urological condition. Some of the reasons this may occur are self-mutilation with psychiatric disturbances, sexual need, accidents, iatrogenic injuries, or revenge and marriage breakdown. Since this is a rare injury there is no standardized method to treat this. Micro-surgical repair seems to be the most effective method to achieve a return of sensation and erectile function. [12]

Testicular trauma

Testicular trauma is an injury to one or both testicles. Types of injuries include blunt, penetrating and degloving. The testes are located within the scrotum, which hangs outside of the body, and do not have the protection of muscles and bones. This makes it easier for the testes to be struck, hit, kicked or crushed, which occurs most often during contact sports. Testicles can be protected by wearing athletic cups during sports. Trauma to the testes can cause severe pain, bruising, swelling, and/or in severe cases even infertility. It can also turn in its space, causing a blockage of the vascular supply, this condition requires immediate medical attention (testicular torsion). In most cases, the testes—which are made of a spongy material—can absorb some impact without serious damage.

See also

Related Research Articles

<span class="mw-page-title-main">Sexual intercourse</span> Penetrative sexual activity for reproduction or sexual pleasure

Sexual intercourse is a sexual activity typically involving the insertion and thrusting of the male penis inside the female vagina for sexual pleasure, reproduction, or both. This is also known as vaginal intercourse or vaginal sex. Sexual penetration has been known by humans since the dawn of time, and has been an instinctive form of sexual behaviour and psychology among humans. Other forms of penetrative sexual intercourse include anal sex, oral sex, fingering and penetration by use of a dildo, and vibrators. These activities involve physical intimacy between two or more people and are usually used among humans solely for physical or emotional pleasure. They can contribute to human bonding.

<span class="mw-page-title-main">Vagina</span> Part of the female reproductive tract

In mammals and other animals, the vagina is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix. The vaginal introitus is normally partly covered by a thin layer of mucosal tissue called the hymen. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.

<span class="mw-page-title-main">Hymen</span> Membrane that surrounds or partially covers the vaginal opening

The hymen is a thin piece of mucosal tissue that surrounds or partially covers the vaginal introitus. A small percentage are born with hymens that are imperforate and completely obstruct the vaginal canal. It forms part of the vulva and is similar in structure to the vagina. The term comes straight from the Greek, for 'membrane'.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<span class="mw-page-title-main">Episiotomy</span> Surgical incision of the perineum and the posterior vaginal wall

Episiotomy, also known as perineotomy, is a form of female genital mutilation that consists of the surgical incision of the perineum and the posterior vaginal wall generally done by an obstetrician. This is usually performed during the second stage of labor to quickly enlarge the aperture, allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

<span class="mw-page-title-main">Penile fracture</span> Rupture of the fibrous coverings that envelop the peniss erectile tissue

Penile fracture is rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the penis's corpora cavernosa. It is caused by rapid blunt force to an erect penis, usually during vaginal intercourse, or aggressive masturbation. It sometimes also involves partial or complete rupture of the urethra or injury to the dorsal nerves, veins and arteries.

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It may correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

<span class="mw-page-title-main">Rectovaginal fistula</span> Medical condition

A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina.

Hymenorrhaphy or "hymen reconstruction surgery" is the surgical alteration of the hymen, with the goal of producing bleeding on intercourse and a tight vaginal introitus, falsely believed to indicate virginity. The term comes from the Greek words hymen meaning "membrane", and raphḗ meaning "suture". It is also known as hymenoplasty, although strictly this term would also include hymenotomy.

<span class="mw-page-title-main">Rape</span> Type of sexual assault usually involving sexual intercourse without consent

Rape is a type of sexual assault involving sexual intercourse, or other forms of sexual penetration, carried out against a person without their consent. The act may be carried out by physical force, coercion, abuse of authority, or against a person who is incapable of giving valid consent, such as one who is unconscious, incapacitated, has an intellectual disability, or is below the legal age of consent. The term rape is sometimes casually inaccurately used interchangeably with the term sexual assault.

<span class="mw-page-title-main">Non-penetrative sex</span> Sexual activity that usually excludes penetration

Non-penetrative sex or outercourse is sexual activity that usually does not include sexual penetration, but some forms, particularly when termed outercourse, include penetrative aspects, that may result from forms of fingering or oral sex. It generally excludes the penetrative aspects of vaginal, anal, or oral sex, but includes various forms of sexual and non-sexual activity, such as frottage, manual sex, mutual masturbation, kissing, or hugging.

<span class="mw-page-title-main">Perineoplasty</span>

Perineoplasty denotes the plastic surgery procedures used to correct clinical conditions of the vagina and the anus. Among the vagino-anal conditions resolved by perineoplasty are vaginal looseness, vaginal itching, damaged perineum, fecal incontinence, genital warts, dyspareunia, vaginal stenosis, vaginismus, vulvar vestibulitis, and decreased sexual sensation. Depending upon the vagino-anal condition to be treated, there are two variants of the perineoplasty procedure: the first, to tighten the perineal muscles and the vagina; the second, to loosen the perineal muscles.

<span class="mw-page-title-main">Perineal tear</span> Medical condition

A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most common form of obstetric injury. Tears vary widely in severity. The majority are superficial and may require no treatment, but severe tears can cause significant bleeding, long-term pain or dysfunction. A perineal tear is distinct from an episiotomy, in which the perineum is intentionally incised to facilitate delivery. Episiotomy, a very rapid birth, or large fetal size can lead to more severe tears which may require surgical intervention.

<span class="mw-page-title-main">Postcoital bleeding</span> Non-menstrual vaginal bleeding during or after sexual intercourse

Postcoital bleeding (PCB) is non-menstrual vaginal bleeding that occurs during or after sexual intercourse. Though some causes are with associated pain, it is typically painless and frequently associated with intermenstrual bleeding.

<span class="mw-page-title-main">Penile-vaginal intercourse</span> Form of human sexual intercourse

Penile-vaginal intercourse or vaginal intercourse is a form of penetrative sexual intercourse in human sexuality, in which an erect penis is inserted into a vagina. Synonyms are: vaginal sex, cohabitation, coitus, intimacy, or (poetic) lovemaking. It corresponds to mating or copulation in non-human animals.

A penile injury is a medical emergency that afflicts the penis. Common injuries include fracture, avulsion injury, strangulation, entrapment, and amputation.

A urogenital fistula is an abnormal tract that exists between the urinary tract and bladder, ureters, or urethra. A urogenital fistula can occur between any of the organs and structures of the pelvic region. A fistula allows urine to continually exit through and out the urogenital tract. This can result in significant disability, interference with sexual activity, and other physical health issues, the effects of which may in turn have a negative impact on mental or emotional state, including an increase in social isolation. Urogenital fistulas vary in etiology. Fistulas are usually caused by injury or surgery, but they can also result from malignancy, infection, prolonged and obstructed labor and deliver in childbirth, hysterectomy, radiation therapy or inflammation. Of the fistulas that develop from difficult childbirth, 97 percent occur in developing countries. Congenital urogenital fistulas are rare; only ten cases have been documented. Abnormal passageways can also exist between the vagina and the organs of the gastrointestinal system, and these may also be termed fistulas.

Vaginal trauma is injury to the vagina. It can happen during childbirth, sexual assault, and accidental occurrences.

References

  1. 1 2 3 Anderson, Sarah; McClain, Natalie; Riviello, Ralph J. (2008-06-28). "Genital Findings of Women After Consensual and Nonconsensual Intercourse". Journal of Forensic Nursing. 2 (2): 59–65. doi:10.1111/j.1939-3938.2006.tb00060.x. ISSN   1556-3693. PMID   17073065. S2CID   38838082.
  2. 1 2 3 4 5 6 7 Frioux, Sarah M.; Blinman, Thane; Christian, Cindy W. (January 2011). "Vaginal lacerations from consensual intercourse in adolescents". Child Abuse & Neglect. 35 (1): 69–73. doi:10.1016/j.chiabu.2010.08.006. ISSN   0145-2134. PMID   21315449.
  3. 1 2 3 4 Uğurel, Vedat; Özer, Dilek Pınar; Varol, Füsun (May 2014). "A Rare Case of Rectovaginal Fistula Following Consensual Vaginal Intercourse". The Journal of Sexual Medicine. 11 (5): 1345–1348. doi:10.1111/jsm.12472. ISSN   1743-6095. PMID   24877178.
  4. ↑ Schmidt Astrup, Birgitte; Lykkebo, Annemette Wildfang (2014-10-23). "Post-coital genital injury in healthy women: A review". Clinical Anatomy. 28 (3): 331–338. doi:10.1002/ca.22476. ISSN   0897-3806. PMID   25346095. S2CID   43703076.
  5. 1 2 Symeonidis, Nikolaos; Ballas, Konstantinos; Micha, Aikaterini; Psarras, Kyriakos; Pavlidis, Theodoros (February 2015). "Consensual Intercourse Resulting in an Extensive Rectovaginal Tear: An Extremely Rare Occurrence". The Journal of Sexual Medicine. 12 (2): 572–575. doi:10.1111/jsm.12754. ISSN   1743-6095. PMID   25376118.
  6. 1 2 Hoffman, Barbara L. (2011). Williams Gynecology (2nd ed.). New York: McGraw-Hill Medical. ISBN   9780071716727.
  7. ↑ "Vagina: What's normal, what's not". Mayo Clinic. Retrieved 2018-02-10.
  8. ↑ "Vaginal Trauma: You Fell On What? | Texas Children's Hospital". www.texaschildrens.org. Archived from the original on 2018-02-10. Retrieved 2018-02-10.
  9. ↑ "Genital Injury - Female". www.seattlechildrens.org. Archived from the original on 2018-02-10. Retrieved 2018-02-10.
  10. ↑ Albers, L.; Borders, N. (2007). "Minimizing Genital Tract Trauma and Related Pain Following Spontaneous Vaginal Birth". Journal of Midwifery & Women's Health. 52 (3): 246–253. doi:10.1016/j.jmwh.2006.12.008. PMID   17467591 . Retrieved 2018-02-10.
  11. ↑ Greenberg's Text-Atlas of Emergency Medicine. Lippincott Williams & Wilkins. 22 November 2004. p. 318. ISBN   978-0-7817-4586-4 . Retrieved 15 October 2012.
  12. ↑ Yang, Kunlin; Liu, Yu; Wang, Wei; Xiao, Yunxiang; Li, Xuesong; Zhou, Liqun (January 2020). "Successful penile replantation after macroscopic repair using vein blood-letting therapy". Urology Case Reports. 28: 101069. doi:10.1016/j.eucr.2019.101069. ISSN   2214-4420. PMC   6864311 . PMID   31763173.
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