Evaluation and management of female lower genital tract trauma
- Marc R Laufer, MD
Marc R Laufer, MD
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Gretchen Makai, MD
Gretchen Makai, MD
- Director, Minimally-Invasive Gynecologic Surgery
- Department of Obstetrics and Gynecology
- Christiana Care Health System
Any female child, adolescent, or adult with a complaint of vaginal pain or genital bleeding or swelling should undergo a careful examination to look for vulvar or vaginal trauma or laceration. It should also be kept in mind that patients with vulvar or vaginal trauma sometimes present with abdominal or low back pain as their chief complaint. External lesions can be identified easily, but need to be carefully evaluated for deeper extension. Internal lesions are more difficult to assess.
Patients may not be forthcoming with details of the events that caused the trauma, therefore identifying those at risk is a crucial step in management. The history should always be consistent with the physical findings; further questioning is important if there is a discrepancy. The possibility of sexual abuse or assault must always be considered.
Evaluation and management of female lower genital tract trauma is reviewed here. The differential diagnosis of female genital tract bleeding is discussed separately. (See "Differential diagnosis of genital tract bleeding in women".)
Obstetric — Lacerations of the cervix, vagina, and/or vulva commonly occur during childbirth. Risk factors associated with lower genital tract trauma in the obstetric setting include nulliparity, large baby, precipitous birth, operative delivery, and/or episiotomy. Obstetric injuries are discussed in detail separately. (See "Operative vaginal delivery" and "Shoulder dystocia: Risk factors and planning delivery of at risk pregnancies" and "Approach to episiotomy" and "Obstetric fistulas in resource-limited settings".)
●Vulvar trauma – The rich vascular supply to the perineum places it at risk for bleeding from trauma. Vulvar hematomas are the most common sequelae.
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- PHYSICAL EXAMINATION
- PERIOPERATIVE MANAGEMENT
- REPAIR OF LACERATIONS
- - Superficial lacerations
- - Deep lacerations
- - Extension beyond the vagina
- MANAGEMENT OF HEMATOMAS
- FOLLOW UP
- SUMMARY AND RECOMMENDATIONS