Female genital injuries

The main diagnostic sign of trauma to the external genitalia and vagina is bleeding, which is especially dangerous when damage to the cavernous bodies of the clitoris ( corpus cavernosum clitoridis ). Occasionally, a rupture of the fleshy septum of the vagina can cause bleeding, which requires surgical hemostasis . Usually one or more sutures are placed on the vessels, chipped with novocaine and adrenaline hydrochloride . Sometimes a short-term pressure of the vessel is enough.

With hypoplasia of the external genitalia, their atrophy in older women, as well as in the presence of scars after injuries and ulcers of inflammatory origin, rupture of the vaginal mucosa can continue inward to the external genital organs, urethra, and perineum . In these cases, to achieve hemostasis, a surgical suture will be required.

Vaginal rupture can occur if the woman’s abnormal body position during intercourse , violent sexual intercourse, especially when intoxicated, as well as when using foreign objects for violence , etc. A typical damage in such circumstances is rupture of the vaginal arches.

Doctors often observe large damage to the external genitalia and adjacent organs. Forensic practice abounds with such observations, especially when examining juveniles who have been raped . Large ruptures of the vagina, rectum , vaginal arches up to penetration into the abdominal cavity and prolapse of the intestine are characteristic. In some cases, the bladder is damaged. Untimely diagnosis of vaginal ruptures can lead to anemia , peritonitis and sepsis .

Damage to the pelvic organs is diagnosed only in a specialized institution, therefore, with the slightest suspicion of injury, patients are hospitalized in a hospital.

Foreign bodies introduced into the genital tract can cause serious disorders. From the genital tract, foreign bodies of various shapes can penetrate into adjacent organs, the pelvic and abdominal cavities. Depending on the circumstances and purposes for which foreign bodies were introduced into the genital tract, the nature of the lesions may vary. There are 2 groups of damaging objects:

• entered for therapeutic purposes;
• introduced for the purpose of having a medical or criminal abortion .

The list of circumstances and causes of damage to the genital tract at the household level can be significantly expanded: from small objects, often of plant origin (beans, peas, sunflower seeds, pumpkins, etc.) that children hide during games and modern vibrators for masturbation to random large items used for purposes of violence and hooliganism.

If it is known that the damaging object had no sharp ends and cutting edges, and the manipulations were immediately stopped, then we can limit ourselves to observing the patient.

The leading symptoms of genital trauma are pain , bleeding , shock , fever , expiration of urine from the genital tract and intestinal contents . If the damage occurred in an outpatient setting, then of the two solutions - to operate or not to operate - the first is chosen, because this will save the patient from fatal complications.

The only right solution would be hospitalization. At the same time, given the vagueness of the nature and extent of the injury, even in the presence of severe pain, pain relief is contraindicated.

Many difficulties associated with the provision of emergency and emergency medical care in case of injury, blood loss and shock can be successfully overcome if, in the interests of continuity at the stages of medical evacuation, the ambulance team, deciding on the transportation of the patient, transfers information about this to the hospital where the patient will be delivered.

Damages of this nature are caused by various reasons, for example, a fall on a pointed object, an attack by cattle, etc. There is a known case when a girl bumped into a stump with sharp boughs while skiing from a mountain. In addition to a sciatic fracture, she had multiple injuries of the pelvic organs.

A wounding object can penetrate the genitals directly through the vagina , perineum , rectum , abdominal wall , damaging the genitals and adjacent organs ( intestines , bladder and urethra , large vessels). A variety of lesions corresponds to their multi-symptom. It is significant that under the same conditions, some victims develop pain, bleeding and shock, while others do not even experience dizziness, and they independently get to the hospital.

The main danger is injuries to internal organs, blood vessels and contamination of the wound. This can be detected already at the initial examination, stating the outflow from the wound of urine, intestinal contents and blood. However, despite the large amount of damage and the involvement of arteries, in some cases, bleeding may be minor, probably due to crushing of tissues.

If during examination at the prehospital stage in the genital tract an object is found that injured, then it should not be pulled out, as this may increase bleeding.

These damages can occur, for example, in road traffic accidents . Extensive hemorrhages, even open wounds, can form in tissues compressed by two moving rigid objects (for example, in the soft tissues of the vulva when pressed against the pubic bone under the action of a solid object).

A feature of bruised wounds is a large depth of damage with a relatively small size. Damage to the cavernous bodies of the clitoris is a threat - a source of severe bleeding, which is difficult to surgical hemostasis due to additional blood loss from the places of clamping , needle injections and even ligatures .

A long pressing of the site of damage to the underlying bone may not give the expected results, however, they still resort to it for the period of transportation to the hospital.

Bleeding may also be accompanied by an attempt to achieve hemostasis by chipping a bleeding wound with a solution of novocaine and adrenaline hydrochloride . It should be borne in mind that damage to the external genital organs as a result of trauma with a blunt object is more often observed in pregnant women , which is probably due to increased blood supply, varicose veins under the influence of sex hormones .

Subcutaneous hematomas can occur under the influence of trauma with a blunt object, and if the venous plexus of the vagina is damaged, hematomas form that extend along the sciatic-rectal depression ( fossa ischiorectalis ) and perineum (on one or both sides).

Large intercellular spaces can accommodate a significant amount of flowing blood. In this case, hemodynamic disturbances up to shock indicate hemorrhage.

Damage to the external genitalia can be accompanied by trauma to adjacent organs (polytrauma), in particular a fracture of the pelvic bones. In this case, very complex combined injuries can occur, for example, rupture of the urethra, tearing of the vaginal tube from the vestibule ( vestibulum vaginae ), often with damage to the internal genital organs (rupture of the uterus from the vaginal arches, hematomas, etc.).

With polytrauma, it is rare to avoid gluttony and limit oneself to conservative measures. The multiple nature of the lesions is indications for emergency hospitalization in the surgical department of a multidisciplinary hospital.

Mostly described in violent acts against a person on a sexual basis. Usually these are simple wounds with cut edges. They can be superficial or deep (internal genital and adjacent organs are damaged). The topography of the internal genital organs is such that it provides them with fairly reliable protection. Only during pregnancy, the genitals, going beyond the pelvis, lose this protection and can be damaged along with other organs of the abdominal cavity.

Regarding the frequency of bullet injuries of the internal genital organs, there are almost no comprehensive statistics, however, in modern conditions, women can become victims of violence. Therefore, this type of damage in the practice of an ambulance doctor is not at all excluded.

The experience of military conflicts showed that most wounded women with damage to the pelvic organs die at the prehospital stage from bleeding and shock. Bullet wounds are not always adequately evaluated. The task is facilitated with a through wound . In the presence of inlet and outlet openings of the wound canal, it is not difficult to imagine its direction and the probable amount of damage to the internal genital organs. The situation is completely different when there is a blind bullet wound.

In making the decision, the ambulance doctor must proceed from the assumption that as a result of the injury, multiple injuries of the internal organs occurred until the opposite is proved. In this regard, the most appropriate hospitalization of the wounded in a multidisciplinary hospital with surgical and gynecological departments.

Particularly dangerous are bullet wounds during pregnancy. Damage to the uterus usually causes great blood loss. A wounded pregnant woman must be hospitalized in the obstetric department of a multidisciplinary hospital.

• Obstetrics and gynecology - Gromova A.M. - Pidruchnik - 2002 p.
• Gіnekologіya - Grishchenko V. І. - Pidruchnik - 2007 p.
• Obstetrics and gynecology - Nevidkladny stani
• Traumatic childcare of statutory organs - P. T. Leshchinsky, V. V. Makagonova
• Punish the Ministry of Health of Ukraine for Reanimatology - Nevidladnі stand in the gynecologist.