Injury of genital organs
Last reviewed: 23.04.2024
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Virtually all traumas of the genital organs occur in men and include damage to the testicles, scrotum and penis. Genital mutilation in women (removal of the clitoris, preserved in some cultures) is regarded by many as a trauma to the sexual organs and a form of cruel treatment of children.
Most of the damage to the testicles occurs as a result of blunt trauma, penetrating lesions are less common. A dull injury can cause hematoma or, in case of severe damage, a testicle rupture.
Damage to the scrotum can be caused by infection, burns, separation.
Mechanisms of damage to the penis are diverse. Perhaps most often there are injuries from the zipper of the trousers. Fractures of the penis (ruptures of cavernous bodies) most often occur during sexual intercourse, can be accompanied by damage to the urethra. Other variants of damage include amputations (in case of trauma caused by the patient himself, or when clothes get into the mechanisms at work) and infringement (the most common reason is the use of rings to enhance the erection). Penetrating damage, including animal bites and gunshot wounds, are less common and, as a rule, are combined with damage to the urethra.
These injuries can be complicated by the development of Fournier gangrene (necrotizing fasciitis) caused by a mixed aerobic-anaerobic infection. Predisposing factors include alcohol abuse, diabetes mellitus, prolonged bed rest, immunodeficiency and chronic bladder catheterization. Complications of genital injuries include erectile dysfunction, infection, tissue loss and urethral stricture.
[Symptoms and Diagnosis of Genital Trauma
Damage to the testicles and scrotum may not manifest, or manifest as edema and soreness. Hematoceles, painful upon palpation formation, can develop with a rupture of the gallbladder; When the sheath of the vagina breaks, bruising in the groin and perineum is possible. Fractures of the penis manifest sharp puffiness, hemorrhages and, sometimes, visible and palpable deformation. Necrotizing infection of the scrotum is initially manifested by pain, swelling and hyperthermia, rapidly progressing.
Diagnosis of external injuries of the scrotum and penis is based on clinical data. Egg damage is diagnosed with scrotal ultrasound. Retrograde urethrography should be performed for all patients with genital tract injury because of the high risk of combined urethral injury.
The clinical course of necrotizing gangrene of the scrotum is rapidly progressive, accompanied by necrosis of the skin and even septic shock. Diagnosis is based on data from a physical examination. At first, the scrotum is edematous, tense, with hemorrhages, then blisters, darkening and crepitus appear. In the early stages of patients, the systemic manifestations of sepsis are noted, the severity of which is disproportionate to the local manifestations of the disease.
How to examine?
Treatment of genital injuries
Patients with penetrating wounds of the testicle or its rupture in need of surgical treatment, patients with suspected rupture, but which is not confirmed with ultrasound, nevertheless, a surgical audit is shown. All gaps and penetrating lesions of the penis also require surgical revision and correction. In the case of the viability of the amputated segment of the penis, its microsurgical implantation is shown. If the trouser zipper is damaged, after lubricating it with oil and performing local anesthesia, one attempt can be made to unfasten the zipper. If this is not possible, the lightning bolt snaps with powerful clippers, and it easily diverges.
Treatment of necrotizing infections of the scrotum is more complicated. Patients with this infectious lesion should begin intravenous administration of broad-spectrum antibiotics; in the operating room perform a thorough necroctomy of the involved zones. Often it is necessary to impose colostomy and cystostomy. An attempt to restore the scrotum can be done only after the complete elimination of the infection.