Genital trauma

Lore & Background

Genital trauma encompasses injuries to the vagina, vulva, penis, and testes. Vaginal trauma can occur from insertion of objects, sexual intercourse (consensual or non-consensual), straddle injuries, or episiotomy. It is difficult to differentiate injuries from consensual sex versus sexual assault based solely on physical examination. Women are three times more likely to have vaginal injuries from forced assault than from consensual sex. Risk factors for vaginal injury during consensual sex include first sexual experience, pregnancy, vigorous penetration, vaginal atrophy, and certain sexual positions, such as the missionary position with legs hyperflexed, which can cause deep penetration and vaginal wall rupture.

Reader's Guide

Vulvar trauma is more common in prepubertal children due to small labial fat pads and higher activity levels, often from straddle injuries. Penile trauma includes abrasions from zippers, fractures from sexual activity, and rare amputations, which are urological emergencies. Testicular trauma, often from contact sports, can cause severe pain, swelling, and infertility, though the testes can absorb some impact. Treatment for genital trauma may involve suturing, surgical repair, or blood transfusions for severe bleeding. The study of genital trauma has improved with tissue staining dyes and colposcopy, but research remains sparse, especially on minor injuries that do not require surgery.

Did You Know?

• The missionary position with legs hyperflexed is the most likely position for vaginal laceration.
• Penile amputation is a rare injury and is considered an emergency urological condition.