Vaginal trauma is injury to the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

. It can happen during

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...

, sexual assault, and accidental occurrences. In adults, the vagina is largely protected from trauma due to the protective function of the

mons pubis In human anatomy, and in mammals in general, the ''mons pubis'' or pubic mound (also known simply as the mons, and known specifically in females as the ''mons Venus'' or ''mons veneris'') is a rounded mass of fatty tissue found over the pubic symp ...

and

labia majora The labia majora (singular: ''labium majus'') are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum. Together with the labia minora they form the labia of the vulva. The labia majo ...

. This protection is lacking in girls who lack a protective fat layer to protect the vagina. 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 of a 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 also occurs during an

episiotomy Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening ...

and vaginal childbirth. Avoiding vaginal injuries during childbirth will help to prevent depression, hospital readmissions, and perineal pain.

Signs and symptoms

Signs and symptoms include:

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than ...

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...

faintness Syncope, commonly known as fainting, or passing out, is Unconsciousness, a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain ...

vaginal discharge Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amou ...

, embedded object in the vagina, genital pain, swelling,

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the Human nose, nose. Vomiting can be the result of ailments like Food-poisoning, foo ...

, painful urination, inability to urinate, presence of a

wound A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...

, report of

sexual abuse Sexual abuse or sex abuse, also referred to as molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using force or by taking advantage of another. Molestation often refers to an instance of sexual assa ...

, and

blood in the urine Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. “Gross hematuria” occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable w ...

. A

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 ...

can form after vaginal trauma. Imaging can identify the presence of the accumulated blood.

Cause

Pregnancy related

During childbirth, vaginal or cervical injuries can occur and will likely require surgery to correct them. The vagina is sometimes injured during the course of labor and perineal tears extend from the vagina to various points of the perineum.

Non pregnancy related

Non-obstetric causes include: sexual assault,
STAT!Ref Online Electronic Medical Library
sup> ubscription required/sup> consensual sex, fracture of the pelvis, foreign object inserted into the vagina, jet ski and water-skiing accidents or blunt force trauma, such as being kicked or kneed in the groin during an athletic competition.

Risk factors

Risk factors include: first episode of consensual intercourse,

breastfeeding Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that br ...

menopause 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 ...

, and medication

side effect In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...

Prevention

A safe environment can be created for young children in addition to keeping small objects out of reach.

Treatment

Treatment begins with a thorough assessment. The presence of someone to provide support during the examination is very beneficial. Such support is especially prioritized in cases of vaginal trauma due to sexual assault. A support person provides emotional support and can help minimize the risk of re-traumatization. Those treating victims employ sexual assault nurse/forensic examiners (SAN/FEs) with specific training to care for those who have experienced rape or sexual assault. They are able to conduct a focused medical-legal exam. If such a trained clinician is not available, the emergency department has a sexual assault protocol that has been established for treatment and the collection of evidence.

References

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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 i ...

Trauma types Acute pain Rape Sexual abuse Violence against women Injuries of abdomen, lower back, lumbar spine and pelvis