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Genital trauma
Last reviewed: 07.07.2025
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Almost all genital trauma occurs in men and involves damage to the testicles, scrotum, and penis. Female genital mutilation (clitoral removal, which persists in some cultures) is widely considered to be genital trauma and a form of child abuse.
Most testicular injuries result from blunt trauma; penetrating injuries are less common. Blunt trauma may cause hematoma or, if severe, rupture of the testicle.
Scrotal injuries can be caused by infection, burns, or avulsion.
The mechanisms of penile injury are varied. Perhaps the most common is injury from a trouser zipper. Penile fractures (ruptures of the corpora cavernosa) most often occur during sexual intercourse and may be accompanied by damage to the urethra. Other types of injury include amputations (in case of self-inflicted trauma or when clothing gets caught in machinery at work) and strangulation (the most common cause is the use of rings to enhance erection). Penetrating injuries, including animal bites and gunshot wounds, are less common and are usually combined with damage to the urethra.
These injuries may be complicated by the development of Fournier's gangrene (necrotizing fasciitis), caused by a mixed aerobic-anaerobic infection. Predisposing factors include alcohol abuse, diabetes mellitus, prolonged bed rest, immunodeficiency, and chronic urinary catheterization. Complications of genital injuries include erectile dysfunction, infection, tissue loss, and urethral stricture.
[ Symptoms and diagnosis of genital injuries
Testicular and scrotal injuries may be asymptomatic or may present with swelling and tenderness. A hematocele, a painful mass, may develop when the tunica albuginea ruptures; when the vaginal tunica ruptures, bruising may occur in the inguinal region and perineum. Penile fractures present with severe swelling, hemorrhage, and sometimes visible and palpable deformity. Necrotizing infection of the scrotum initially presents with pain, swelling, and hyperthermia, and progresses rapidly.
Diagnosis of external scrotal and penile injuries is based on clinical data. Testicular injuries are diagnosed by scrotal ultrasound. Retrograde urethrography should be performed in all patients with genital trauma due to the high risk of associated urethral injury.
The clinical course of necrotizing gangrene of the scrotum is rapidly progressive, accompanied by skin necrosis and even septic shock. Diagnosis is based on physical examination data. At the beginning of the disease, the scrotum is edematous, tense, with hemorrhages, then blisters, darkening and crepitus appear. In the early stages, patients experience systemic manifestations of sepsis, the severity of which is disproportionate to local manifestations of the disease.
How to examine?
Treatment of genital injuries
Patients with penetrating injuries of the testicle or its rupture require surgical treatment, patients with suspected rupture, which is not confirmed by ultrasound, nevertheless, are indicated for surgical revision. All ruptures and penetrating injuries of the penis also require surgical revision and correction. In case of viability of the amputated segment of the penis, its microsurgical replantation is indicated. In case of damage by a trouser zipper, after lubricating it with oil and performing local anesthesia, one attempt can be made to unzip the zipper. If this fails, the zipper is cut with powerful nippers, and it easily comes apart.
Treatment of necrotizing scrotal infections is more complex. Patients with this infection should be started on broad-spectrum intravenous antibiotics; the involved areas are carefully debrided in the operating room. Colostomy and cystostomy are often necessary. Scrotal reconstruction should be attempted only after the infection has been completely eradicated.