Genital Trauma Research Articles

Acute Ischemic Priapism: An AUA/SMSNA Guideline.

Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction. A comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report. This Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement. All patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified approach, some men may be treated with intracavernosal injections of phenylephrine alone, others with aspiration/irrigation or distal shunting, and some may undergo non-emergent placement of a penile prosthesis.

MP04-09 POPULATION-BASED ANALYSIS OF OCCUPATION RELATED GENITOURINARY INJURIES: MALE EXTERNAL GENITALIA STILL AT RISK

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-09 POPULATION-BASED ANALYSIS OF OCCUPATION RELATED GENITOURINARY INJURIES: MALE EXTERNAL GENITALIA STILL AT RISK Ruth Blum, Shawn Mendonca, Sun-Ming J. Pan, Jane Kurtzman, and Steven Brandes Ruth BlumRuth Blum More articles by this author , Shawn MendoncaShawn Mendonca More articles by this author , Sun-Ming J. PanSun-Ming J. Pan More articles by this author , Jane KurtzmanJane Kurtzman More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Occupational injuries are a significant problem in the United States, resulting in a large economic burden in medical care, lost wages and time from work. Little is known about genitourinary (GU) trauma in the workplace. This is the 1st population-based and largest cohort report in the literature. METHODS: The National Trauma Data Bank (NTDB) database was queried for all patients with a GU (adrenal, bladder, kidney, penis, scrotum, ureter, or urethra) and ″work-related″ injury from 2007 to 2016. Outcomes were sub-stratified by external GU injuries versus intra-abdominal injuries, as well as blue collar versus white collar jobs. Chi-squared analysis was utilized to compare characteristics between each GU injury. Polynomial logistic regression to assess if characteristics favored any GU injury. Multivariate regression analysis was used to determine variables predictive of GU injuries. RESULTS: 2893 traumatic GU injuries were identified. 2748 (95%) patients were male and 140 (5.0%) female. Mean age 41.3 years (range 15-85). Mean injury severity score (ISS) 20.7 (range 1-75). Mean length of stay 12.6 days (range 1-249 days). Charleson Comorbidity Index , 0 - 2 in 1947 (67%). GU injuries: kidney (1149, 39.7%), adrenal (574, 19.8%), urethra (310, 10.7%), bladder (300, 10.4%), scrotum (270, 9.3%), penis (135, 4.7%), testes (119, 4.1%), and ureter (36, 1.2%). Associated injuries: liver 8.1%, spleen 12.2%, thorax 35%, lower extremity 11%, vertebral 32%. 202 (7.0%) patients died. All genital injuries were lacerations, grade (G) 1-3 and intra-abdominal urotrauma G 1-3, except kidney (13.6% G 4 and 3.31% G 5). Construction was associated with the highest frequency of GU injuries (N=663, 22.0%) and agriculture, forestry, and fishing (AFF) second (N=179, 6.2%). On polynomial logistic regression, AFF was associated with a higher risk of penis (OR 4.1, p=0.0009), urethra (OR 2.5, p=0.0005) and scrotum (OR 2.4, 0=0.04) injuries vs. other blue-collar professions. In the multivariate model, AFF (p≤.0001) and construction (p≤.0001) were predictive of external GU injuries. CONCLUSIONS: Construction and AFF jobs are the most dangerous for GU injury and are particularly prone to external genital injuries. A safety issue clearly persists in these professions, and thus would benefit from additional safety regulations, protective undergarments, or equipment guards. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e70-e70 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruth Blum More articles by this author Shawn Mendonca More articles by this author Sun-Ming J. Pan More articles by this author Jane Kurtzman More articles by this author Steven Brandes More articles by this author Expand All Advertisement Loading ...

MP04-07 THE EPIDEMIOLOGY OF PLAYGROUND EQUIPMENT-RELATED GENITAL INJURIES IN CHILDREN: AN ANALYSIS OF UNITED STATES EMERGENCY DEPARTMENTS VISITS, 2010-2019

INTRODUCTION AND OBJECTIVE:Playgrounds are a common source of injury in children. Genital injuries associated with playground equipment are scarcely investigated. Herein, we sought to evaluate the ...

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage.

This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.

Physical and Biological Evidence in Sexual Assault Cases Reported in District Rawalpindi

Forensic medical examination serve two purposes i.e.to preserve mental and physical health of the victim as well as collection of forensic evidence 1,2. Collection and documentation of evidence whether in form of injures or biological material is help to validate the objects and the accoster's past.3 The outline of wounds also has a criminal worth because they are related to the result of lawful proceedings4. The works assessment explores the variables linked to genital harm occurrence and places that are informed in a sequence of surveying examinations of medicinal proceedings 5.The occurrence of perfect indication of erotic harms in the U.S. ranges from 5-27%, in Italy 11.5%, in Thailand 42% and in Denmark 38%. In Israel, as in another place in the countries, few cases of erotic stabbing in children have vibrant indication of a erotic style. 6,7,8,9. Objective: To evaluate incidence and comparison of physical and biological evidence in victims of sexual assault and their relation to time interval between examination and incident. Methodology: The retrospective cross sectional study was placed during June 2019 to December 2020 on cases reported in the DHQ Hospital Rawalpindi with follow up reports. Total 108 cases were reported during this period. Data was collected from DHQ Hospital Rawalpindi with follow up reports. Examination results were included presence and absence of physical injuries located genital region and other parts of the body, and presence and absence of biological evidence .The fallouts of investigation were linked to parameters such as sex, age and length of time since assault. Data was analyzed by using SPSS version 19 Results: Female victim: Out of 108 cases 77 was female.61% was unmarried and 39% was married (Figure 1). 44.2% cases was fall between age range of 16-20years.2.6%cases between age group of 45-50 years.51.9% cases belong to rural area. While 48.1% cases belong to urban. Vaginal swab was positive in 79.2%.genital injuries was present in 13% cases.11.7% married and 1.3% unmarried. Other injuries present in 6.5%married.7.8%unmarried. Fresh hymen injuries present in 13%.old in 41.6%. Male victims: Total 31 in number.67.7%in rural area ,while 32.3% in urban.45.2% (14)between age group 11-15 years .Anal swab was positive in 64.5%.(20 in number).Bleeding was present in 32.3% (10)cases. Bruises in 41.9%.abrasion was present in 48.4%.(15)25% in 11-15 years age group. Genital injuries was present in 45.2%(14).other injuries 28.1%.anal swab with injuries positive in 34.4%.negative in 12.5%.Finding on clothes was present on 12.5%. Conclusion & Recommendations: Rape or sexual assault in the absence of prior sexy knowledge, genital or physique harms are usually found in adolescents. The possibility of rape in nonappearance of any hurt, with or deprived of permission cannot be excluded. A competent forensic examiner must examines and follow up the victims of sexual violence. The forensic examiner must have technical and scientific skills that are medicinal and stabbing history taking, whole body examination, and organic article collects, recording damages, clinical pediatric practice, interpretation of findings and reports and prosecution. Keywords: Genital harms, adolescent, body injuries, Prosecution

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery

PurposeTo evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery.MethodsWe evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups.ResultsThe combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003).ConclusionS-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.

Gastrointestinal Chlamydia-Induced CD8+ T Cells Promote Chlamydial Pathogenicity in the Female Upper Genital Tract.

Chlamydia is known to both ascend to the upper genital tract and spread to the gastrointestinal tract following intravaginal inoculation. Gastrointestinal Chlamydia was recently reported to promote chlamydial pathogenicity in the genital tract since mice intravaginally inoculated with an attenuated Chlamydia strain, which alone failed to develop pathology in the genital tract, were restored to develop hydrosalpinx by intragastric coinoculation with wild-type Chlamydia. Gastrointestinal Chlamydia promoted hydrosalpinx via an indirect mechanism since Chlamydia in the gut did not directly spread to the genital tract lumen. In the current study, we further investigated the role of CD8+ T cells in the promotion of hydrosalpinx by gastrointestinal Chlamydia. First, we confirmed that intragastric coinoculation with wild-type Chlamydia promoted hydrosalpinx in mice that were inoculated with an attenuated Chlamydia strain in the genital tract 1 week earlier. Second, the promotion of hydrosalpinx by intragastrically coinoculated Chlamydia was blocked by depleting CD8+ T cells. Third, adoptive transfer of gastrointestinal Chlamydia-induced CD8+ T cells was sufficient for promoting hydrosalpinx in mice that were intravaginally inoculated with an attenuated Chlamydia strain. These observations have demonstrated that CD8+ T cells induced by gastrointestinal Chlamydia are both necessary and sufficient for promoting hydrosalpinx in the genital tract. The study has laid a foundation for further revealing the mechanisms by which Chlamydia-induced T lymphocyte responses (as a 2nd hit) promote hydrosalpinx in mice with genital Chlamydia-triggered tubal injury (as a 1st hit), a continuing effort in testing the two-hit hypothesis as a chlamydial pathogenic mechanism.

Prevalence of Adult Female Genital Trauma After Acute Sexual Assault: The Need for a Universal Definition of Genital Trauma.

Examination of the adult female genitalia after an acute sexual assault may reveal findings interpreted by the examiner as injuries, which may be linked to later legal outcomes. There is no consistent definition in the literature regarding what findings constitute genital trauma after sexual assault. We studied how the prevalence of genital trauma is impacted by the inclusion/exclusion of various genital findings reported in the literature. A retrospective descriptive chart review of the sexual assault forensic records from a provincial regional sexual assault treatment center was conducted over a 4-year period and included 67 female patients, 12 years old and over, who reported being sexually assaulted in the previous 72 hours and received a complete forensic examination. We studied the prevalence of genital trauma, using eight definitions of trauma, as well as the percentage of each type of genital finding within this population. The prevalence of genital trauma in this population ranged from 52%, the majority, to 31% of women, depending on the definition of trauma utilized. Forty-one percent of the findings, the greatest number overall, were redness. Bruises, abrasions, and tears (lacerations), the components of blunt force trauma, accounted for 4%, 15%, and 14% of the findings, respectively. A universal definition of what findings constitute genital trauma after acute sexual assault is required if the examiner, as expert witness, is to compare findings in a given case with the broader literature and assist the court in ensuring an informed process of decision making.

A Retrospective Study on Presentation, Patterns, and the Prevalence of Injuries in Alleged Sexual Assault Cases, Presented to District General Hospital Gampaha from July 2018 to April 2019

<strong><em>Introduction:</em></strong><em> </em>Sexual abuse is an undesired sexual behavior by one person upon another. In Sri Lanka, all sexual abuse cases are expected to be examined by a medico-legal specialist before the court procedure. This study was conducted to identify the presentation, pattern, and prevalence of injuries among the sexual abuse victims presented to District General Hospital Gampaha. The findings of this study will help to improve the knowledge on different variables that can influence or affect the medico-legal opinion, and the management of victims including prevention. <em> </em> <strong><em>Methodology:</em></strong><em> </em>A retrospective descriptive study was conducted using medico-legal records of all the cases with alleged sexual abuse reported to DGH Gampaha, during the 10 months from July 2018 to April 2019. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26 with descriptive statistics. Bivariate analysis and multiple logistic regression model used where necessary. <em> </em> <strong><em>Results:</em></strong><em> </em>A total of 103 alleged sexual assault cases were assessed with 85% females, and remaining 15% were male victims. The median age of victims was 15years. Almost all the perpetrators were males and the mean age is 31 years. There was 92% probability of an abuser become a known person or a relative of the victim. Ten percent (10%) (n=10) of victims sustained non-genital injuries following a sexual assault with injuries in more than one site and 11 % (n=11) victims had genital injuries. About 40% (n=40) of victims gave a history of repeated abuse with no statistically significant difference among the genders (chi-square =2.6, p = 0.105&gt;0.05). On multiple logistics regression, those who had a history of repeated abuse and who became pregnant following the abuse were significantly associated with the length of time to reporting (Exp (B) = 3.082; 95% CI, 1.224 - 7.76; p-value = 0.017&lt;0.05 and (Exp (B) = 17.066; 95% CI, 2.001 -145 .56, p-value =0.009&lt;0.05) respectively). Sexually assaulted unmarried females have a 13% (95% Confidence interval, 06% - 22%) chance of getting pregnant. <em> </em> <strong><em>Conclusion:</em></strong><em> </em>Female sex, and less than 16 years of age, is the most vulnerable group. Early adolescents had comparatively higher genital injury prevalence. Also, the genital injury prevalence was almost four-fold among the victims that presented to the medicolegal examination within one week or less. All the victims, who had anal/perianal injuries, were less than 15-year-old males. History of repeated abuse and presence of pregnancy was significantly associated with the duration of time to report to the hospital. 13% of sexually assaulted unmarried females being presented with pregnancy, is an alarming finding and needs evaluation with further studies.

The pattern of genito-anal injuries in female sexual assault cases in Mumbai, India

BackgroundThe prevalence of genito-anal injuries in victims of sexual assault depends on several factors. Forensic examination, documentation of injuries and preparing report thus becomes challenging for healthcare providers as the presence or absence of injuries aids in the subsequent laying of charges against the accused. This paper aims to determine the pattern of genito-anal injuries and factors associated with the laying of charges against the accused. MethodsA cross-sectional study of victims of sexual assault (n = 440) was conducted between 2014 and 2017 in a specialized tertiary care center in a Metropolitan city in India. The results were expressed as proportion and percentage. Chi-squared test was used to analyse data using SPSS version 23.0. ResultsThere was no statistically significant association between reporting within 72 h of sexual assault and the arrest of the accused. Vaginal and anal bleeding were present in 4.1% cases and 2.7% cases respectively. Genital and anal injuries were present only in 30.9% of cases. The most common genito-anal injury was laceration (72.08%). Posterior fourchette injury (most common site) was present in 27.94% of cases. Extra genital injuries were found in 24.09% of victims. The most common extra genital injury was abrasion (26.42%). Intoxicants were found in the blood of 4.8% of victims and spermatozoa/semen was found in swabs from 3.6% of victims. In this study 25.9% of perpetrators were arrested, out of which 84.37% of adult victim’s cases and 94.23% of minor (<18 years) victims cases went to trial. In 3.12% of adults and 0.6% of minor victims, the accused was found guilty and sentenced to imprisonment. The presence of genital injury, visualization of sperm by direct microscopy, assailant known to the victim and pregnancy of the victim were not significantly associated with the laying of charges (p > 0.05) and were dropped from the model. The odds ratio (OR) for charge-laying associated with the age of the victim < 18 years was 3.02 (95% confidence interval [CI] 1.02–9.14). Arrests in accused of both victims > 18 years age and < 18 years age were more common if the accused was known to the victim. Injuries in victims < 18years of age and > 18 years of age did not appear to have any influence over the arrest. A notable finding was a high proportion (75.51% in <18 years and 77.77% in >18 years) of cases where an arrest was effected in adults and child sexual assault cases where no injuries were described. ConclusionThis study shows the pattern of genito-anal injuries and factors associated with the laying of charges in sexual assault cases in a developing country. It should be noted that most of those exposed to sexual assault do not have visible genito-anal injuries. We report that age is significantly associated with the presence of genito-anal injuries. However, it is important to note that the presence of injuries does not prove rape, neither its absence disproves the act. The information gathered by a meticulous forensic examination does make a difference in the legal outcome for cases of sexual assault.

Evidence in forensic practice

Evidence supporting much of clinical forensic medicine practice is deficient or dated. This presentation highlights the results from two local research projects which looked at various aspects of the sexual assault forensic examination.1.Do they who slide first, slide best: Jurisdictions within Australia and internationally differ with regard to preference for who creates the smear from those swabs taken to find DNA from semen. This research sought to articulate the function of slide preparation in sexual assault and to identify whether slide preparation by the forensic examiner, at time of examination, was preferable to slide preparation by forensic laboratory staff, at a later date. It also provided a review of the limited research in this area and posed questions for potential future research.2.Patient perception of forensic imaging: Historically, photography used in forensic documentation of injuries (especially genital injuries), sustained during an alleged sexual assault, has been controversial. This study explored the immediate and short-term experiential impacts of forensic photography from the victims’ perspective and supports the case for the routine use of forensic photography, with patient consent.

The concealed morbidity of buried penis: a narrative review of our progress in understanding adult-acquired buried penis as a surgical condition.

Adult acquired buried penis (AABP) is a condition of entrapment of the phallus resulting most commonly from morbid obesity and formation of cicatrix with other etiologies including genital lymphedema, hidradenitis and trauma. The incidence of this syndrome is invariably connected to the increasing prevalence of obesity. The purpose of this review is to examine the current literature in AABP with a focus on the morbidity of AABP and perioperative management. The discussion and literature surrounding buried penis reconstruction started with the goal of correcting a cosmetic problem and has recently become fairly successful in this aim with an over 85% rate of successful reconstruction in many series with a more uniform surgical approach. The most recent trends have examined the significant burden of morbidity and even mortality that AABP can place on patients as it contributes to risk of penile cancer, urethral strictures and mood disorders. Studies in this space have shown that surgical repair can be successful in improving quality of life for patients with AABP and the removal of the offending pathophysiology suggests its success in correcting the physical morbidities. New directions for research and management of this condition should include a focus on educating providers and patients to make reconstruction more accessible to patients in need as AABP continues to journey toward mainstream acceptance as a surgical condition.

Male genital injuriesattending a tertiary hospital inawestern region of Nepal:Atwo-year snapshot.

Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic interventionmaylead to chances of loss of fertility due to infections and anatomical disruption of normalcy.This study highlights the clinical scenarios, etiology and outcome of malegenitalinjury cases that were managed at a tertiary care center in Nepal.Such injuriesare not frequently encounteredaslack of reportingbypatients means cases are rare.The present study isthefirst from Nepal which depicts a comprehensive report on male genital injuries. Methods:A retrospective analysis of discharge summarieswas carried out and the cases of male genital injuries were reviewed duringJune2020. All the treatedcasesduring thetwo-yearperiod from April 2018 to April 2020at Lumbini Medical College, Nepalwere included in the study. Results:There wereeightcases ofgenitaltrauma admitted and treated during the study period. All thepatients weremales and age ranged fromsixto 71 years with a mean age of33±21.45years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause inthemajority of cases. Conclusion:Superficial injuriestothepenis and scrotum do not require surgical exploration and could be managed conservatively. However,deeperand complicated injuries, testicular preservation, the functionality of the partandcosmetic issuesaretaken into consideration which might requireamulti-disciplinary approach.Apart from themedical issues pertaining togenital injuries, there arelegal and psychological aspects of such eventstoo which should not beignored.

Genital injuries and allegation of digital vaginal penetration – A retrospective examination of forensic case notes

ObjectiveTo determine the prevalence of genital injuries following alleged sexual assault by digital penetration of the vagina in the absence of penile penetration of the vagina or anus in women age 16 and over; and to compare with the prevalence of genital injuries following alleged sexual assault by penile vaginal penetration in the absence of penile penetration of the anus or digital penetration of the vagina and/or anus. Population1428 adults and children attending a forensic medical examination between September 2017 and January 2020 at the Haven sexual assault referral center situated in Paddington, London, UK. DesignRetrospective review of forensic notes. MethodsEligible cases were identified through the standardized forensic notes and relevant data was extracted. Results109 cases of women 16 years and over alleging digital penetration only and 110 cases of women 16 years and over alleging penile vaginal penetration only were included. The 110 cases of penile vaginal penetration only were randomly selected for comparison purposes. 7.6% of Haven attenders fulfilled the digital penetration only category. In this category, the patients mean age was 27.2 years. Thirteen patients (11.9%) sustained genital injuries; of those with genital injuries, eleven (84.6%) sustained one or more abrasions. The most common site of injury was the labia minora (46.2%). There were no significant differences between the 2 groups (digital penetration only and penile vaginal penetration only) in terms of number of patients with genital injuries, type or location of injury. There were differences regarding the relationship between patient and assailant: more stranger assaults in the digital penetration group 27/109 (29%) vs 13/110 (12%) in the penile penetration group. There was one assault by multiple assailants in the digital penetration group and 8 (7.3%) in the penile penetration group. In the digital penetration group there was more alcohol use [71/109 (65.1%) vs 62/110 (56.4%)] but less drug use [21/109 (19.3%) vs 30/110 (27.3%)] than in the penile vaginal penetration group. ConclusionThe majority of patients examined following an allegation of digital vaginal penetration without penile penetration sustained no injuries. Of those who did, abrasions were the most common type of injury, with the inner labia minora being the most common location for injury. There were no significant differences with the injuries seen in the penile vaginal penetration group in terms of number of patients with genital injuries, type or location of injury.

Rat Bite As A Cause Of Significant Genital Injury: A Case Report

Rat bite is generally a rare form of animal bite suffered by humans. It is said to account for about 1-3% of all cases of animal bites to humans. Such bites commonly involve the limbs and rarely on the genitalia. Rat bite resulting in significant genital injury evidenced by scrotal skin loss with exposure of the testis has not been reported in the literature as far as the authors are aware. We hereby report the case of rat bite to the genitalia of an adult male with resultant significant injury.

Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019

To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children. We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates. During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change=+ 2.6%; r2=0.121, P=.326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October. Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.

The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study

IntroductionBetween 2017 and 2018 a national quality improvement initiative was introduced incorporating point-of-care viscoelastic haemostatic assays (VHA) to guide blood product transfusion. Laboratory coagulation profiles, use and results of VHA, and administration of blood products were investigated. MethodsA two-year prospective cohort study of maternal outcomes of women experiencing massive postpartum haemorrhage (PPH) >1000 mL in Wales. In this study, cases of massive PPH (≥2500 mL and/or ≥5 units red blood cell (RBC) transfusion) were identified. ResultsMassive PPH occurred in 349 of 60 914 maternities (rate 5.7 per 1000). There were no deaths from PPH. Intensive care unit admission and/or hysterectomy occurred in 34/311 (10.9%) and 16/347 (4.6%), respectively. The leading cause of massive PPH was genital tract trauma (107/349, 30.6%). Two hundred and seventy-nine (80.6%) required RBC transfusion and 79/345 (22.9%) received at least one blood coagulation product. Results of VHA were recorded in 245/349 (70.2%), with 44/98 (44.9%) women tested in the first six months vs 63/77 (81.8%) in the final six months. Hypofibrinogenaemia (Clauss fibrinogen <2 g/L or FIBTEM A5 <12 mm) was observed in 56/328 (17.1%) of women, thrombocytopaenia (count <75 × 109/L) in 17/334 (5.1%) and either PT or aPTT >1.5×reference range in 10/293 (3.4%). ConclusionIn Wales, the use of VHA in cases of massive PPH increased over time, enabling clinicians to adopt a targeted, patient-specific approach to blood product administration, with only 22.9% of women receiving blood coagulation products and 17.1% having a documented clotting abnormality.

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

BackgroundThere is a lack of national report of the labour neuraxial analgesia (NA) rates in China in recent years, especially after the national promotion policy. The adverse maternal and perinatal outcomes associated with NA in China are also unknown. The aim of this study is to estimate the trends of NA rates from 2012 to 2019, to evaluate the effect of national policy on promoting NA and to identify the association between NA and adverse outcomes in China.MethodsWe used the individual data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019, covering 438 hospitals from 326 urban districts or rural counties in 30 provinces across China. The analysis was restricted to singleton pregnant women who underwent vaginal delivery at or after 28 completed weeks of gestation. We estimate the trends of NA rates between 2012 and 2019, both at the national and provincial levels using Bayesian multilevel model. We also estimated the effect of the national pilot policy launched in 2018 using interrupted time-series analysis and identified the association between NA and adverse outcomes using modified Poisson regression combined with propensity score analysis.ResultsOver the study period, 620,851 of 6,023,046 women underwent vaginal delivery with NA. The estimated national NA rates increased from 8.4% in 2012 to 16.7% in 2019. Most provinces experienced the same rapid rise during this period. The national pilot policy accelerated the rise of the rates. No differences were observed between women with NA and without any analgesia in the incidence of uterine atony, placental retention, intrapartum stillbirths and 1- and 5-min Apgar scores lower than 7. However, women with NA had higher incidences of genital tract trauma (adjusted relative risk (aRR) 1.53, 95% confidence interval (CI) 1.04–2.26) and maternal near miss (aRR 1.35, 95% CI 1.08–1.69), only in hospitals which were not covered by the national pilot policy and usually lack of sufficient equipment and personnel.ConclusionsThe national policy can effectively increase the NA rate. However, as genital tract trauma and maternal near miss may increase in low-resource hospitals, but not in high-resource hospitals, further study is required to identify the reasons.

Medications at the Emergency Department After Recent Rape.

Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability.

Diagnosis and management of genital injuries in girls: 14-year experience.

Pediatric patients with genital injuries are often recommended to receive an examination under general anesthesia; however, detailed clinical data of such patients are rarely reported. A single-center retrospective review was conducted in 45 girls less than 16years of age with genital injuries between January 2005 and December 2018. The median patient age was 5.0years. Forty-two patients were hospitalized, of whom 38 required an examination under general anesthesia and all consequently required surgical repair. The diagnosis obtained after a thorough examination under general anesthesia was inconsistent with the diagnosis obtained at the emergency room in five patients. In 20 patients, the source of bleeding was not clarified at the time of initial examination at the emergency room; four of these patients were later revealed to have vaginal or rectal injuries that had been overlooked during the examination at the emergency room. Injuries occurring in the bathroom were the most frequent and tended to be serious. Multiple injuries were found in 10 patients. The exterior of the labia minora was the most commonly injured site, found in 18 patients. We analyzed the clinical data of girls with genital injuries in detail, which allowed us to find a detailed classification of injured sites and the characteristics of serious cases, and to re-recognize the importance of a thorough examination under general anesthesia.