Genital injury

• Alternative Names

  Scrotal trauma; Straddle injury; Toilet seat injury

• Considerations

  Genital injuries can be very painful and can bleed heavily. It can affect the reproductive organs as well as the bladder and urethra. The amount of damage can range from minimal to severe. Temporary as well as permanent damage can be done.

  Young girls (usually less than 4 years of age) may insert foreign objects into the vagina as part of a developmentally-normal exploration of the body. These objects may include toilet tissue, crayons, beads, pins, or buttons.

  To rule out sexual abuse, the young girl should be asked by the health care provider how the object got in her vagina.

  In cases of rape or sexual abuse, a medical examination is necessary. It is essential for the victim's health as well as to prevent the spread of infectious diseases.

  In young boys, one of the most common causes of genital injury is having the seat slam down while they are using the toilet. Another common cause of genital injuries is having the feet slip while they are climbing or playing (such as on monkey bars) and landing with the legs on each side of the bar (straddle injury). Falling onto the crossbar of a bicycle is also a common cause of straddle injury to the genitals.

  Another cause of genital trauma in young boys is entrapment of the scrotum, penis, or foreskin in a zipper. This may occur while the zipper is either opened or closed. The injury may be minimal or significant enough to require medical attention.

• Causes
  • Foreign body placed in the vagina
  • Assault
  • Rape
  • Sexual abuse
  • Zipper injury
  • Trauma
• Symptoms
  • Abdominal pain
  • Bleeding
  • Bruising
  • Affected area has changed in shape
  • Faintness
  • Object embedded in a body opening
  • Groin pain or genital pain (can be extreme)
  • Swelling
  • Urine drainage
  • Vomiting
  • A wound
  • Urination, painful or inability to urinate
  • Foul-smelling vaginal discharge
• First Aid
  1. Reassure the victim and try to keep them calm. As first aid is administered, be sensitive to the victim's privacy -- shield the injured area.
  2. To control bleeding, use direct pressure. Place a clean cloth or sterile dressing on any open wounds. If the vagina is bleeding severely, pack the area with sterile gauze or clean cloths unless a foreign body is suspected.
  3. Apply cold compresses to help reduce swelling.
  4. If the testicles have been injured, support them with a sling made from towels and applied like a diaper.
  5. If an object is embedded in a body opening or wound, leave it alone. Taking it out may cause further damage.
  6. Seek medical attention.
• Do Not
  • DO NOT overlook the possibility of internal bleeding.
  • DO NOT volunteer your opinions about the circumstances.
  • DO NOT accuse or confront the victim.
  • DO NOT disturb possible evidence of assault or abuse, unless a medical emergency exists. If you suspect assault or abuse, do not allow the victim to change clothes, bathe, or shower.
  • DO NOT allow the victim to walk, unless absolutely necessary.
  • DO NOT attempt to remove a foreign body yourself.
• Call immediately for emergency medical assistance if
  • There is any pain or swelling in the genital area
  • The foreign body was sharp
  • There is bleeding
  • There is concern about sexual abuse
  • The patient is unable to urinate
  • The urine is bloody
• Prevention

  Teach safety to young children and create a safe environment for them. Also, keep small objects out of the reach of toddlers.

• References

  Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 3.

Review Date: 9/30/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.