Genital area injuries in girls may occur as a result of trauma such as the child’s falling on a hard floor with his legs open, or as a result of penetrating injuries caused by traffic accidents, sexual assaults or penetrating tools. It may occur in newborn babies as a result of birth trauma. The extent of the injury can range from a simple laceration without even active bleeding to extensive injuries involving injury to the pelvic bones, urethra, vagina, and rectum. In such traumas, it is often difficult to understand the extent of the injury because of the child’s fear. Therefore, examination under general anesthesia is the most reliable way. If a perforation associated with the bladder, rectum and peritoneal cavity (intra-abdominal) is suspected, vaginal examination should be performed.
May be required for cystoscopy, vaginoscopy, or rectoscopy. Primary closure of simple laceration injuries with absorbable sutures is usually sufficient. A catheter can be inserted to prevent a urination difficulty that may develop after edema.
**Genital injuries in girls can be handled according to their anatomical locations.
Injuries to the vulva (outer part of the vagina): Hematomas appear as a round, hard, ecchymotic, tender mass.
Vaginal injuries: Usually seen as a result of a penetrating injury. The injury can range from a superficial injury to the mucosa to a tear that reaches deep into the pelvis. After checking the integrity of surrounding tissues such as bladder and rectum, necessary surgical treatment should be applied. When a hematoma located inside the vagina is detected, the decision is made according to the size of the lesion. While small hematomas can be expected to disappear spontaneously, a growing hematoma should be surgically evacuated, the vessels causing the bleeding should be ligated, and repaired in accordance with the anatomy after hemostasis is achieved. Sexual harassment cases generally prefer to hide the situation due to the effect of the trauma they have experienced. The physician should be careful when encountering a child who has been sexually abused. The external examination should be done carefully, the presence of erythema, edema, bruises, peeling, and whether the hymen has been touched should be determined. Findings that are objective evidence, such as the presence of fluid or hair, should be evaluated. The anal sphincter should also be examined for injuries. After the necessary notification has been prepared, the treatment of injuries should be done appropriately.
Genital Injuries in Men:
These are injuries that are mostly seen as a result of blunt traumas and that the scrotum (bag) and testicles (ovaries) are affected more frequently. Even mild trauma can lead to significant scrotal edema and ecchymosis, and it can be difficult to identify a possible testicular rupture. With ultrasonography, it can be understood how deep the injury is.
In addition, it is possible to encounter situations where the scrotum is opened, the testicles go out of the scrotum, and sometimes the testicles are completely separated. In such cases, the anaerobic infection base should be removed by very good wound cleaning and if there is a tear in the testicles, the testicles should be sutured after the necessary tissue cleaning as soon as possible. If there is a skin defect in the scrotum, the open area should be closed with skin grafts to be taken from the thigh area after the infection subsides.
Penile injuries: Simple skin lesions and injuries to deeper penile tissues can be seen. In such cases, if there is a hematoma (blood clot), it should be drained and the injured deep tissues should be sutured. Skin defects in the penis must also be closed with graft techniques to prevent curvature and shortening that may develop later. Another common injury to the penis is the injuries caused by the foreskin being stuck in the zipper. In these patients, the zipper can be easily separated with local anesthesia. However, in cases where this cannot be achieved, circumcision should be performed by separating the zipper from the trousers. In addition, injuries in the form of friction injuries that develop during slipping from places such as trees, stairs, etc. may occur in children. The most serious type of penile injury is the complete amputation of the penis, in which cases repair should be attempted using microsurgical methods. In addition, if the hair wire wraps around the penis and compresses the penis, cutting the hair or tape that compresses the penis relaxes the tip of the penis. Although the penis is usually straightened, partial or complete amputation or urethrocutaneous fistulas may rarely develop.
