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Vaginal Bleeding in the Prepubertal Patient
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Trauma (see Chapter 19, “Genital Trauma”)MUST rule out non-accidental abuse; history of injury does not match examNote: Straddle injuries typically involve the labia/vulva but are rarely penetrating to the vagina
Abdominal and Genitourinary Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Injury to the external genitalia may be due to any mechanism but sexual violence must be considered in the setting of isolated genital trauma.62 Physical examination by an appropriately trained clinician is vital and forensic considerations are important but should not impact life-saving interventions. Ultrasound can be used to assess testicular injury.63 There may be associated urinary tract injuries.64 Genital injuries are rarely life-threatening,65 but carry significant physical and psychological morbidity and the long-term effects on fertility and sexual function may be crucial.66 In the presence of severe trauma to the testicles, sperm salvage may need to be considered and early specialist involvement is critical.
Vulvar and Vaginal Trauma and Bartholin Gland Disorders
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Malak El Sabeh, Mostafa A. Borahay
Worldwide, the most common cause of genital trauma is obstetric injury that usually occurs during vaginal deliveries. Nonobstetric vulvar and vaginal trauma is relatively uncommon due to their anatomic location. Such trauma includes blunt injuries, consensual and nonconsensual intercourse, female genital mutilation, and, less commonly, burn injuries. The extent of the injuries varies from minor bruising and lacerations that may not require any medical or surgical interventions to severe life-threatening complications requiring emergent care.
Penile reconstruction: An up-to-date review of the literature
Published in Arab Journal of Urology, 2021
Nicholas Ottaiano, Joshua Pincus, Jacob Tannenbaum, Omar Dawood, Omer Raheem
Penetrating trauma is much more common in the military setting compared to that of the general public, accounting for 14.8% and 0.57% of all patients presenting with external genital trauma, respectively [16,17]. Ballistic wounds from projectiles can cause penetrating injury to the penis. The damaged area can be classified into zones to better aid in understanding of how each area of tissue will respond to injury. The primary tract the penetrating projectile leaves behind from coming into direct contact with tissue by directly piercing through is referred to as zone 1. Another temporary zone created from the shearing of tissue via energy waves from the projectile resulting in blood vessel rupture, muscle damage, and a zone of haemorrhage adjacent to zone 1 is designated as zone 2. Lastly, zone 3 extends further into the tissue because of the dispersion of shock waves. The recovery of tissues in zones 2 and 3 is variable, as injury progression often takes days to progress. This variability is especially pronounced when immediate debridement is prolonged after initial injury [17].
Genetic polymorphism of glial cell-derived neurotrophic factor (GDNF) in male infertility
Published in British Journal of Biomedical Science, 2019
S Shabani, F Mashayekhi, SS Shahangian, Z Salehi
We recruited 185 men with infertility and 200 fertile men as controls. At least three seminal fluid analyses, carried out after 3–5 days of sexual abstinence, were performed to ascertain their infertility status. Semen analysis has been performed according to World Health Organization recommendations [8]. We excluded patients with a positive history of epididymo-orchitis, prostatitis, genital trauma, cryptorchidism, chromosomal abnormalities, testicular torsion, bilateral absence of the vas deferens, varicocele, hypogonadotropic hypogonadism, seminal infections, drug and alcohol user; and also chronic diseases such as diabetes. All the patients provided a medical history and underwent physical examinations. Controls were healthy men with normal semen parameters who had at least one child without benefiting from assisted reproductive technologies. The study has been performed in compliance with the 1964 Helsinki declaration.
UK Paramedics Confidence in Identifying Child Sexual Abuse: A Mixed-Methods Investigation
Published in Journal of Child Sexual Abuse, 2018
Paramedics participants did not mention specifically what signs and symptoms of genital trauma they would be looking for in abuse victims, which suggests a lack of forensic knowledge but also indicates a broader lack of anatomical knowledge. Findings of genital injury are rare in sexually abused girls and even rarer in sexually abused boys (Herrmann, Banaschak, Csorba, Navratil, & Dettmeyer, 2014). Dubow, Giardino, Christian, and Johnson (2005) evaluated how well pediatric chief residents could label anatomic structures on two different photographs of female prepubertal genitalia. They compared their findings with a similar 1997 study (Paradise, 1997) which measured agreement about genital examination findings in evaluating children for suspected sexual abuse. While the 2005 study participants did slightly better than the more diverse 1997 group, neither set of participants 8 years apart achieved 100% accuracy in identifying basic genital structures correctly on two different photographs. These findings serve to show that even speciality doctors with years of specific training and education have difficulty in determining anatomical structures and physical signs of abuse. Thus, paramedics should not be relying on this type of examination to identify possible sexual abuse but should be focusing on a range of alternative signs and details from the history of events. The history of events is often the most valuable component in the evaluation of child sexual abuse and given that paramedics will only undertake a limited physical examination, the efficacy of history taking should be emphasized.