2. • Alternate Names
• vulvar injuries
• vaginal injuries
• injury to the genitals
• straddle injury
3. • Definition
• A genital injury to a female is an injury to the
reproductive organs of a girl or a woman.
4. • The external genitalia has a rich blood supply. As
a result, relatively minor injuries to the area may
bleed excessively. This is particularly true when
injuries involve the :
• hymen,
• vagina,
• labia.
• The injury may be the result of childbirth, rough
intercourse, sexual assault, or an accident or other
trauma.
5. Risks
• Childbirth is the most likely cause of genital injury.
A tear in the vulva or vagina during pregnancy and
delivery may occur as a result of:
• an episiotomy, which is a cut made in the opening
of the vagina and just outside the vagina during
childbirth
• tears in the vaginal opening from delivering a large
infant
• the use of forceps or vacuum suction during
childbirth
6. Perineal Lacerations: classified four
degree
• First-degree
• lacerations involve the fourchette, perineal skin,
and vaginal
• Second-degree
• mucous membrane lacerations involve, in addition,
the fascia and muscles
• Third-degree
• to involve the anal sphincter.
• fourth-degree
• laceration extends through the rectum's mucosa to
expose its lumen.
7. Symptoms:
• Inability to hold flatus and feaces.
• Soreness over the perineal region is due to
constant irritation by the stool.
• Absence of perineum.
• Visible dimple on skin.
8. Prevention:
• More attention should be paid not to perineum but
to the controlled delivery of head.
• Delivery by early extension is to be avoided.
• To deliver head inbetween contraction.
• To perform timely episiotomy.
• To take care during delivery of the shoulders as
the wider bisacromial diameter emerges out of the
introitus.
9. Vaginal Lacerations
Isolated lacerations involving the middle or
upper third of the vagina.
Such lacerations frequently extend deep into
the underlying tissues and may give rise to significant
hemorrhage.
Lacerations of the anterior vaginal wall in close
proximity to the urethra. They are often superficial
with little to no bleeding.
large Lacerations require extensive repair,
indwelling catheter is placed.
10. Injuries to the Cervix
The cervix is lacerated in more than half of all
vaginal deliveries
Most of these are less than 0.5-2cm, although
deep cervical tears may extend to the upper third
Such tears heal rapidly and are rarely the source
of complications
11. Puerperal hematomas
• Incidence of puerperal hematomas was found
• to vary from 1 in 300 to 1 in 1000 deliveries
• Risk factor: Nulliparity, episiotomy, and
• forceps
• Classified: vulvar, vulvo vaginal, Para vaginal,
• or retroperitoneal
12. • Vulvar hematomas
• involve branches of the pudendal artery.
• Para vaginal hematomas
• involve the descending branch of the uterine
artery
13. Treatment
• Smaller vulvar hematomas may be treated
expectantly.
• If pain is severe or the hematoma continues to
• enlarge, the best treatment is prompt incision and
drainage.
• the cavity is surgically closed, and the vagina is
packed for 12 to 24 hours.
14. Penetrating trauma
• Knife and gunshot wounds are the most common
penetrating
• aggravated assaults, suicide attempts, or
attempts to cause abortion
• The incidence of maternal visceral injury with
penetrating trauma is only 15 to 40
• When the uterus sustains penetrating wounds,
the fetus is more Injured
• fetus sustains injury in two thirds of such cases.
15. Management of trauma
• Basic rules: resuscitation including :
• establishing
• ventilation
• arrest of hemorrhage
• treatment of hypovolemia with crystalloid and
blood product
• repositioning of the large uterus away from the
great vessels to diminish its effect on decreased
cardiac output.
• evaluation is continued for fractures, internal
injuries, bleeding sites, placental,uterine, and fetal
injuries
16. Paraclinic pregnant trauma victims have less
radiation exposure than non pregnant controls
screening abdominal sonography followed by
CT scanning for positive sonographic findings.
Penetrating injuries must be evaluated by
radiography. Because clinical response to
peritoneal irritation is blunted during pregnancy.
17. laparotomy approach to exploratory for abdominal
gunshot wounds.
some clinicians advocate close observation for
selected stab wounds.
18. FOREIGN BODIES
• In the vagina:
• Coins, toys, small stones either introduced out of
curiosity by children or perversion in adults.
• Forgotten menstrual tampons or diaphragm,
cervical cap or condom used as contraceptives.
• Packs, swabs
• Forgotten pessaries.
• In the uterus:
• Retained IUCD for a long time.
• Old gauze pieces.
• Articles inserted for procuring abortion.
19. Management
• Once diagnosed, the foreign body is to be
removed. In children, it may not be easy and it is
better to expose the vagina under general
anaesthesia using aural or nasal speculum.
20. • Accidental injuries can be caused by:
• falls
• straddle injuries, for example falling on monkey
bars, a bicycle bar, or a fence
• chemical burns or burns from hot objects
• pelvic fractures
• high-pressure liquid injection, such as from water-
skiing or jet-skiing
21. • Injuries related to sex or assault are due to:
• rough sex
• unusual positions during sex
• having sex for the first time
• sexual abuse
• rape
• physical abuse or assault, such as a foreign object
forcibly placed into the vagina or anus
• child abuse
22. Diagnosis
• It may be hard to do a pelvic exam in woman or girl
who has a genital injury. But without a thorough
exam, a healthcare provider may misjudge the
extent and severity of the injury. Sometimes the
exam is done with the woman or girl under general
anesthesia.
• Other procedures that may be done include:
23. • cystoscopy, an examination of the bladder
• anoscopy, examination of the anus
• proctoscopy or sigmoidoscopy, examination of the
rectum
• laparoscopy, examination of the abdomen
• exploratory surgery of the abdomen
• vaginoscopy, which is a visual examination of the
vagina
24. Treatments
• Treatment varies according to the severity of the
injuries. Treatments may include:
• ice packs, pressure to stop any bleeding, and bed
rest as well as using soaks such as Sitz baths to
promote drainage and healing
• draining any large areas of blood
• suturing of cuts or tears
25. • surgery to repair any damage to other organs
• antibiotics
• estrogen creams to help the vagina heal
• using a urinary catheter, which is a small tube that
allows urine to drain from the bladder
• counseling after sexual abuse
26. side effects of the treatments
• Antibiotics can cause stomach upset, rash, allergic
reaction, and other side effects. Surgery poses a
risk of infection, and bleeding.
27. What happens after treatment for
the condition?
• Bed rest, ice packs, and antibiotics may be needed
for some time depending on the extent of the
injuries. Not having sex for a while will allow the
tissues to heal.
28. • How is the condition monitored?
• A woman or girl should notify her healthcare
provider if she notices any of the following:
• fever
• pain or swelling in the affected area
• bleeding
• dizziness or fainting
• nightmares, sleep disorders, depression, or
thoughts of suicide after sexual abuse
29. long-term effects of the condition:
• Genital injuries need to be treated right away to
prevent bleeding, complications, and long-term
psychological damage. Genital injuries in girls will
very likely create a lot of anxiety for the child as
well as for her parents.
• risks to others:
• A genital injury can pose a risk to a fetus if the
woman is pregnant. Other risks may occur from
some of the secondary effects of genital injury,
such as sexually transmitted diseases
30. Acc. To WHO Female Genital
Injury Management
• Technique
• 1. Conduct a local examination of the genital area.
Check for associated injuries.
• 2. Obtain information about the nature of the object
causing injury; sharp objects may have penetrated
adjacent organs.
• 3. Catheterize the bladder if the patient has urinary
retention. Repair all lacerations unless they are
very superficial. Anaesthesia may be required to
perform a thorough examination and repair of
severe injuries.
• 4. Check for tears of the hymen then introduce a
speculum and examine all the vaginal walls,
fornices and the cervix.
31. • 5.Thoroughly clean the skin with soap and water,
irrigate lacerations with saline and ligate bleeding
vessels. Excise only devitalized tissues.
• 6. Repair deep lacerations with absorbable suture
without tension and the skin with non-absorbable
suture.
• 7. Perform a laparotomy if the peritoneum is
penetrated. For vulval haematomas, infiltrate the
area with local anaesthesia and evacuate the
clots.
33. • Rape
• If there is allegation of rape, make detailed records
of your findings and comply fully with local legal
requirements. Give a dose of penicillin to protect
the patient against bacterial infection. Protect the
patient against pregnancy; use an IUD or
emergency contraception with two birth control
pills immediately and two more in 12 hours. Give
an anti-emetic with the birth control pills.
• Arrange psychological counseling.
34. Prevention
• Vaginal injuries related to high-pressure water
injection can be prevented by wearing protective
clothing such as a wet suit while water or jet skiing.
Keeping one's feet together when entering the
water on a slide will keep water from entering the
vagina.
• Preventing sexual assault may not be possible, but
it is clear that the victim of this brutality should not
be blamed. Women should avoid situations that
can bring physical or sexual harm, such as:
• alcohol or drug use
• being in a dangerous environment
35. • having an abusive partner
• having group sex
• Children should be told that they should not place
objects into the vagina. Also, getting rid of sharp
objects in the tub that they may fall on can prevent
injuries.
