Analysis of non-obstetric vaginal and vulvar trauma: risk factors for operative intervention

Abstract

Vaginal and vulvar trauma may occur accidentally or because of an act of violence. Due to its rarity, little is known about risk factors effecting need for operative intervention. We sought to perform a large descriptive analysis of adult non-obstetric vulvovaginal trauma (VVT) and elucidate risk factors for requiring operative intervention. A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. Patients ≥ 16 years old with vaginal or vulvar trauma were identified. Risk factors for surgical intervention were identified using a multivariable logistic regression analysis. From 2,040,235 female patients, 2445 (< 0.2%) were identified to have VVT with the majority being injury to the vagina (68.6%). In patients with injury to the vagina, age > 65 (OR = 0.41, CI 0.26-0.62, p < 0.001), Injury Severity Score > 25 (OR = 0.66, CI 0.50-0.86, p = 0.01) and victims of rape (OR = 0.39, 95% CI 0.26-0.57, p < 0.001) were less likely to require operative intervention. In patients with injury to the vulva, age > 65 (OR = 0.45, CI 0.21-0.94, p = 0.02), victims of rape (OR = 0.26, CI 0.08-0.87, p = 0.01) and gunshot violence (OR = 0.10, CI 0.02-0.59, p = 0.02) were less likely to require operative intervention, but those with a concomitant injury to the vagina were more likely to require operative intervention (OR = 2.56, CI 1.63-4.03, p < 0.001). Injuries to the vagina or vulva occur in < 0.2% of traumas. Interestingly, in both vulvar and vaginal trauma, older age, and involvement in rape were associated with lower risk for operative intervention. A combined injury to the vagina and vulva increases the need for operative intervention.

Vulva Haematoma following Sexual Assault in an Adolescent Nigerian Girl: A Case Report

“…[15] Conservative management is associated with a longer duration of hospital stay, increased need for antibiotics, blood transfusion, subsequent surgical intervention, and higher mortality rates. [4,15] The index case was managed surgically because the haematoma was acutely expanding, causing her excruciating pains, with the risk of pressure necrosis; she was discharged after 24 hours in good clinical condition. The surgical incision can be made on the mucocutaneous junction, as was done in the index case, over the point of maximum bulge of the haematoma, or through the vagina mucosa, with similar outcomes.…”

“…[3] The aetiologies include physical trauma, straddle, sports-related injuries, consensual and non-consensual coital injuries. [4] Coital injuries are the most common aetiology, accounting for up to 40% of cases, with sexual assault being the most implicated. [5,6] One in five women will experience sexual assault in their lifetime, with young women and children being the most common victims.…”

A penetrating gravitational bullets (stray bullets, falling bullets) injury to the clitoris: A case report

“…The surgical approach depends on the foreign body's size and location. A complete surgical method is usually achieved [4] , [5] . Under local anesthesia, this patient underwent complete surgical removal of the metallic foreign body.…”