Genital trauma is
trauma
Trauma most often refers to:
*Major trauma, in physical medicine, severe physical injury caused by an external source
*Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic inju ...
to the
genitalia.
History of studying genital trauma
Doctors and nurses have been conducting
sexual assault
Sexual assault is an act in which one intentionally sexually touches another person without that person's consent, or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which ...
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.
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.
Methods of studying and documenting genital injury has greatly improved through the use of
tissue staining dyes and
colposcopy
Colposcopy ( grc, κόλπος, kolpos, hollow, womb, vagina + ''skopos'' "look at") is a medical diagnostic procedure to visually examine the cervix as well as the vagina and vulva using a colposcope.
The main goal of colposcopy is to prevent c ...
. 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.
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.
Women are three times more likely to have vaginal injuries and intercourse-related injuries from a forced assault than from a consensual sexual experience.
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.
There is little research on minor injuries in adult,
pre-menopausal
Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...
women, adolescent girls, and
post-menopausal
Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...
women that do not require surgery or treatment.
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
Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to not enough estrogen. Symptoms may include pain with sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does no ...
and spasm, previous operation or radiation therapy, disproportionate genitalia,
penile ornamentation, and
congenital anomalies
A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can r ...
.
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.
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.
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.
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
Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined are ...
injury. Injuries of this severity that resulted from consensual sex are very rare.
Posterior and right
vaginal fornix
The fornices of the vagina (sing. fornix of the vagina or fornix vaginae) are the superior portions of the vagina, extending into the recesses created by the vaginal portion of cervix. The word "fornix" is Latin for "arch".
Structure
There are t ...
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
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...
that lies slightly to the right, this exposes the right fornix and makes it easier for some type of tearing or trauma to occur.
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
The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
, 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.
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.
The repair of most genital injuries require
suture and the bleeding from the area is usually minimal.
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.
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 trauma
Blunt trauma, also known as blunt force trauma or non-penetrating trauma, is physical traumas, and particularly in the elderly who fall. It is contrasted with penetrating trauma which occurs when an object pierces the skin and enters a tissue ...
s. The most common type of injury is a
straddle injury
In finance, a straddle strategy involves two transactions in options on the same underlying, with opposite positions. One holds long risk, the other short. As a result, it involves the purchase or sale of particular option derivatives that allow ...
, which can be incurred through normal activities like
bicycle riding
Cycling, also, when on a two-wheeled bicycle, called bicycling or biking, is the use of cycles for transport, recreation, exercise or sport. People engaged in cycling are referred to as "cyclists", "bicyclists", or "bikers". Apart from two ...
. Due to the vascularity of the vulva, it may form a large
hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...
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.
Vaginal trauma
Vaginal trauma can occur when something is inserted into the vagina, for example, a sharp object, causing
penetrating trauma
Penetrating trauma is an open wound injury that occurs when an object pierces the skin and enters a tissue of the body, creating a deep but relatively narrow entry wound. In contrast, a blunt or ''non-penetrating'' trauma may have some deep dama ...
.
[ Vaginal trauma can occur as a result as an initial painful sexual experience or sexual abuse. 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 won't stop. Vaginal trauma occurs during an episiotomy.
]
Penile trauma
Penile trauma can take several forms. Abrasions can be caused by a zipper injury, and fractures can be caused by sexual activity. 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.
Testicular trauma
Testicular trauma is an injury to one or both testicle
A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testostero ...
s. Types of injuries include blunt, penetrating and degloving. The testes are located within the scrotum
The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum cont ...
, 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 sport
Contact sports are sports that emphasize or require physical contact between players. Some sports, such as mixed martial arts, are scored on impacting an opponent, while others, including rugby football, gridiron football and Australian rules fo ...
s. 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. In most cases, the testes—which are made of a spongy material—can absorb some impact without serious damage.
See also
* Groin attack
*Penile fracture
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 ...
* Testicular rupture Testicular rupture is a rip or tear in the tunica albuginea resulting in extrusion of the testicular contents, including the seminiferous tubules. It is a rare complication of testicular trauma, and can result from blunt or penetrating trauma, alth ...
* Genital mutilation
References
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Injuries
Sex organs