Ambulance for damage to the external genital organs. Emergency in case of damage to the external genital organs Damage to the external genital organs

Traumatic injury of the vagina is a common and dangerous pathology in women more often of reproductive age. Causes of damage can be as follows:

1. Labor activity is one of the frequent causes of damage to the integrity of the reproductive organs. In this case, lesions from small abrasions and cracks to massive ruptures of the vagina and perineum are observed.
2. Conducting a medical abortion can cause a violation of the female genital mucosa, but is unlikely.
3. Injury to the vaginal mucosa can occur during defloration. Because when a rupture of the fleshy hymen occurs, the walls of the vagina can also be involved in the process, which threatens blood loss due to the presence of a large number of blood vessels.
4. Injury to the vagina occurs during normal sexual intercourse. In this case, most likely, the partners chose an unsuccessful position, or were in a state of intoxication, which dulled the woman's pain. This leads to stretching, in some cases, to rupture of the vaginal wall or displacement of the uterus to the side, which makes it very difficult for a future pregnancy to occur.
5. Rape is the most common cause of rupture of the walls of the vagina, posterior and anterior fornix, up to damage to the rectum and bladder. Often this happens with juvenile victims.
6. Mucosal damage can occur in older women, as the walls of the vagina lose their elasticity. Especially after the onset of menopause. Old scars and scars on the mucosa can also cause injury during sexual intercourse.
7. Mechanical damage to the vagina occurs during rape or the voluntary use of foreign objects in sex. This is especially dangerous when using piercing and cutting objects. It also includes criminal abortions. Such injuries are very dangerous, as they entail ruptures of the walls and arches of the vagina, penetrating wounds into the abdominal cavity with prolapse of the intestines into the vagina, rupture of the urethra and bladder.
8. Little girls can hide various small objects in the genitals during the game. This can lead to injury and inflammation.
9. Injuries to the vagina can be due to injuries from falls, such as pelvic fractures. As a rule, these are hematomas of different sizes.
10. Injuries to the vestibule of the vagina during sex occur with insufficient lubrication and rude, inept behavior of a man, which can lead to inflammatory processes and swelling of the mucosa.
11. A woman can injure the vaginal mucosa with frequent douching, and this leads to the washing out of the normal flora and, accordingly, to the development of chronic infections, since there is no local immunity.

Injuries to the female genital organs, especially minor ones, very often do not give bright symptoms immediately. Complaints of pulling pains in the lower abdomen, tension, pain when walking and sitting, bloody discharge, swelling of the mucosa appear after a while. Feeling discomfort, a woman understands that a vaginal injury has occurred, of course, if there were no health problems before certain events. How serious it is and what the consequences may be, the specialist will determine.

But with any discomfort, you need to contact a medical institution for advice in order to avoid disastrous consequences.

Because even the slightest scratch, and it can be infected, will lead to a serious inflammatory process.

With the above symptoms, there is time to think, since there is no direct threat to life. However, in cases of severe damage to the vaginal mucosa with ruptures and penetrating wounds to nearby organs, you should immediately contact an ambulance or get to the hospital on your own. Very often, a girl in such a state can no longer help herself, so this should be done by a nearby person. It is important to know that every minute counts, as we are already talking about saving lives.

What are the symptoms that you need to see a doctor urgently:

• Pain in the lower abdomen and in the vagina during intercourse or after it. The pain grows and has an intense character.
• Bleeding after intercourse. A pulsating stream of scarlet blood is considered especially dangerous, which indicates damage to a large artery.
• Fever.
• Discharge from the genitals of the contents of the intestine or bladder.
• Confused mind, stupor.
• Inability to urinate or severe pain with it.
• Bloody discharge and high fever after a medical (criminal) abortion or childbirth.

Treatment

First of all, if the condition of the woman allows it, the doctor talks with her about the presence of complaints of a certain nature in her lately and after the injury. Next, an examination of the external genital organs is carried out with the help of fingers and mirrors. The doctor takes swabs from the vagina for clinical analysis and for infection. If necessary, ultrasound and x-rays of the pelvic organs are done. In severe injuries penetrating into nearby organs, cystoscopy can also be performed, if the patient's condition allows.

Any damage to the vaginal mucosa is an indication for hospitalization in a hospital. Superficial abrasions are treated with antiseptic solutions and observed for several days to exclude the spread of infection to healthy tissues.

Serious injuries are treated with surgery. Tears, even minor ones, are indicated to be sutured, otherwise they become infected and form a source of chronic diseases. Also, damage that has not been repaired can later form scars and ulcers in the vagina, which will greatly complicate the life of a woman and jeopardize planned motherhood. Bleeding is stopped by tamponade or suturing of large damaged vessels and vaginal walls.

Hematomas of the genital organs are treated conservatively, prescribing resolving therapy and cold on the affected area. Only in the case of a large volume, the hematoma is opened, blood clots are removed and drainage is established. The stitching is shown next.

In case of rupture of the vaginal vaults, damage to the intestines or bladder, an abdominal operation is performed. Be sure to carry out a transfusion of blood or its components, because with such lesions, blood loss can be significant. The severity of hypovolemia is indicated by which woman will be given every 3 hours until stabilization. Further, in order to prevent the spread of infection, a course of antibiotic therapy is mandatory. General strengthening drugs are also prescribed. The rehabilitation course will be long, especially if the woman has been abused. In such cases, a psychologist should work. After surgical interventions, especially complex ones, one should refrain from sexual activity for up to 4-6 months.

If the genitals of a woman somehow do not correspond to the norm due to an injury, the specialist will definitely recommend plastic surgery. Especially if it's a young girl.

Consequences

The consequences can be very varied. Heaviness in the lower abdomen, sometimes mild pain, a tendency to inflammatory, infectious diseases. It all depends on the severity, area and nature of the lesion of the female genital organs. The time during which a woman was with this problem without qualified medical care is very important. Of course, in cases of complex surgery, especially when removing the reproductive organs, the woman will have a hard time. Firstly, this is a big hormonal failure with all its charms, and secondly, the psychological aspect. In this case, the support of loved ones is very important.

With simple damage and quick, effective intervention by a doctor, the prognosis is very favorable. If a girl has ignored a visit to a specialist for a long time, the infectious process can spread and cause great harm to her body. For example, prolonged inflammation of the vagina, even due to a shallow scratch on the mucosa, can lead to chronic inflammation of the fallopian tubes, and such a pathology is not compatible with pregnancy. But in this case, the consequences will not be associated with an injury, but with a negligent attitude towards one's own health.

Traumatic injuries in gynecology often require emergency medical care. Injuries of the genital organs that occur after a bruise, surgery, abortion or sexual intercourse are observed in 0.5% of patients with a gynecological profile who are being treated in a hospital. Currently, despite heavy bleeding and infection of damaged tissues, deaths are very rare due to antibiotic therapy, anesthesia and transfusiology. Traumatic injuries of the female genitals outside childbirth are associated with the introduction of foreign bodies into the genital tract, with sexual intercourse, especially during rape, with industrial and domestic injuries.

Injuries to the vulva and vagina are observed after a bruise, a fall on a blunt or sharp object, after a blow, injury, rough sexual intercourse. As a result of a bruise, a blow with a blunt object, hematomas are often formed, which is associated with a mechanical effect on the vessel wall and its rupture. Hematomas in the form of blue-purple formations are usually easily diagnosed by a simple examination. From the external genital organs, they pass to the perineum, spread in the perivaginal tissue and are so significant that they are accompanied by the development of acute anemia in the patient. With large hematomas, swelling, severe pain and deformation of the vulva are noted. If the hematoma becomes infected, then the temperature rises, chills appear.

Treatment of hematomas is reduced to conservative-expectant tactics. Bed rest, ice on the hematoma area, vitamins K, P, C, calcium chloride are usually recommended. If the hematoma grows, the patient develops acute anemia, it is recommended to open the blood tumor, remove blood clots, and ligate the bleeding vessel. The cavity is sewn up tightly or drainage is left if there is a risk of hematoma infection (damage and cracks in the vulva). A festering hematoma is opened, its cavity is drained.

The most dangerous are ruptures of blood vessels and tissues in the clitoris, as massive parenchymal bleeding is noted. Therefore, they should be helped as soon as possible.

As a result of a fall on a sharp object or a blow with the horns of an animal, ruptures are observed not only in the perineum, vagina, but also perforation of the vaults, damage to the bladder, rectum.

The correct diagnosis is facilitated by examination in the mirrors, bimanual examination, and symptoms. Treatment of rupture of the vagina, perineum, rectum is to suture them. If a hematoma has formed in the parauterine or paravaginal tissue, then the gap should not be sewn tightly, especially if more than 12 hours have passed after the gap, graduates should be placed in the wound.

During sexual intercourse, traumatic injuries of the external and internal genital organs are sometimes also observed. Such injuries are more often observed in women in old age, with stenosis of the genital organs after suffering inflammatory diseases, with infantilism, with violent sexual intercourse (in a state of intoxication), an incorrect position of a woman and a large penis. Significant destruction of the vagina, ruptures of the vaults penetrating the abdominal cavity, trauma to the rectum are found in rape of minors, and there is often profuse bleeding. Such breaks are sutured. If more than 6 hours have passed since the injury, the sutures are not applied, the wounds heal by secondary intention.

Relatively often there are injuries resulting from the introduction of foreign bodies into the genital tract of women during criminal abortion and onanism.

With the introduction of sharp objects into the vagina, damage to the cervix or body of the uterus is often observed. Penetration of small objects into the uterine cavity or into the abdominal cavity diagnosed by radiography, sometimes a digital examination of the uterine cavity. Depending on the clinic and location, the foreign body is removed by the vaginal route or during abdominal surgery.

Very rarely there are severe injuries of the postoperative period, when surgical instruments are left in the abdominal cavity during the operation. In such cases, an urgent relaparotomy is performed with the extraction of forgotten instruments.

We must not forget that many genital injuries occur on the street, in industrial premises and can be infected. Therefore, it is necessary to ensure careful treatment of the wound and prevention

To serious enough, requiring the help of a doctor.

What is considered trauma?

Of course, “battle wounds” from sex include scratches, bruises from a passionate kiss or hitting your head on the headboard. But still, it is customary to call injuries violations of the integrity of the skin or mucous membranes in the genital area.

In large cities, several women a month turn to doctors with injuries after intimacy. These are far from women of easy virtue, but the most ordinary wives or girlfriends who did not take into account their own anatomical features and their relationship with the size of their partner.

A trifle, but unpleasant

The most harmless, but no less unpleasant, are various kinds of chafing. They occur with very long and frequent sexual intercourse and a lack of lubrication. As a result of friction of the skin against dry mucous membranes, there is swelling of the tissues of the labia minora and the entrance to the vagina, microscopic tears and pain during washing or sex. These injuries are not dangerous, but unpleasant - for a few days they will cool ardent lovers.

During the healing of these wounds, it is worth refraining from sexual intercourse and using antiseptic solutions (Epigen or Miramistin). This will prevent infection of microtrauma. If the soreness does not go away in 3-5 days, you should consult a doctor. Sometimes sexually transmitted infections give similar symptoms.

Minor injuries

Minor injuries can be caused by piercings in intimate places (in the area of ​​the clitoris, labia), growing hair in intimate places or stubble on the face (in the case of oral sex). Using sophisticated postures, you can get dislocations and sprains.

In the heat of passion, bites, bruises on the neck, scratched shoulders and back can appear.

Bites in intimate places are painful and do not heal well on the nipples, labia. On the clitoris, with a bite, a very painful hematoma can even form. Wounds after bites in the intimate area often become infected and bleed, so they require a doctor's consultation if the pain does not go away after a couple of days.

One of the typical traumatic injuries during sex on carpets are burns of the back and lower back, usually in women. They occur due to intense friction on the pile of the carpet by the skin. After some time, redness with severe burning develops on the skin, the integrity of the skin is damaged or forms a blister, as with a burn.

More serious injuries

With very hard sex, injuries to the genital organs are possible, provoking pain in the groin, urination disorders and pain during it. In addition, with a large size of the partner's penis, a woman may develop internal injuries - ruptures of the anterior wall of the vagina or vaginal fornix (the area of ​​​​transition to the cervix).

With a sharp and deep introduction of the penis into the vagina, sharp pain and bleeding can occur, especially if the angle of insertion is not parallel to the axis of the vagina. This can occur when changing positions and throwing the woman's legs back on the man's shoulders. Such injuries are acquired by women whose partners have impressive “dignity” sizes, as well as those who use sexual toys that are not physiologically large.

With deep penetration, injuries to the uterus and ligaments are possible - with a strong push by the penis, a woman may feel a sharp pain in the abdomen. As a result of stretching of the ligaments that hold the uterus, it can shift from its normal axis and threaten reproductive function in the future.

Consequences of unconventional sex

Injuries in non-traditional sex

Injuries during sex in women

The leader in traumatism is anal sex, during intimate relationships, the rectal mucosa can be damaged, a tear of the rectal sphincter can occur with the resulting physiological problems.

During anal sex, cracks can form - they heal for a long time and painfully, can cause inflammation of the rectum (proctitis) and the formation of hemorrhoids. For diseases in the rectal area, anal sex is contraindicated.

If you really want to experiment, use special lubricants, listen very carefully to your feelings and avoid pain.

exotic injuries

Sometimes, in especially emotional and shy women, with sharp sounds or movements, a stress mechanism can work - a strong reflex spasm of the muscles of the vagina with pinching of the penis in it. This condition is called vaginismus, and it is only funny to those who have not been in such a situation.

In order to get out of the “death grip”, a woman needs to tighten the muscles in the press area, simulating going to the toilet “in a big way”. To save his “dignity”, a man needs to insert his index finger into the anus of his partner and pull it back strongly. If these manipulations do not help, call an ambulance, only doctors can relieve the spasm.

Allocate wounds and closed injuries of the external, internal genitalia or simultaneous damage to the external and internal genital organs.

Injuries of the external genitalia(pubis, large and small labia, clitoris, vestibule, hymen, perineum) usually occur as a result of a direct blow. In 75% of cases, there are open lacerations, and in 25% - closed injuries (bruises, bruises).

With injuries of the external genital organs, 30% of the victims experience external bleeding or hematoma formation. Significant bleeding occurs when the venous plexuses and cavernous formations in the clitoris are damaged, as well as when large vessels of the perineum are injured. Depending on the size and prevalence of the hematoma, pain, symptoms of acute blood loss, difficulty urinating, and tepezma are observed. In 15% of cases, hematomas can suppurate, which is accompanied by increased pain, fever, worsening of the general condition.

The diagnosis is established on the basis of an objective study, taking into account the type and nature of the damage. When examining the external genital organs, the localization of the wound, the intensity of bleeding are determined, a hematoma is found, which is often one-sided. A hematoma of considerable size manifests itself in the form of a dense and painful formation. Palpation and examination (vaginal or rectal) allows you to clarify its size and prevalence.

Wounds of the internal genital organs(vagina, uterus, fallopian tubes and ovaries) occur in 60% of all genital injuries. Ruptures of the walls of the vagina are usually accompanied by bleeding from the genital tract, less often by the formation of hematomas. Ruptures of the vagina are more common in the posterior and lateral fornix. Vaginal hematoma can spread to the external genitalia and pelvic tissue. With the growth of the hematoma, arching pains appear, anemia develops in the absence of significant external bleeding. The localization, depth and nature of the vaginal rupture, as well as the size of the hematoma, are established on the basis of anamnesis, vaginal or recto-vaginal examinations, examination of the walls of the vagina and its arches using mirrors. First of all, penetrating wounds of the vagina with damage to the peritoneum, bladder, rectum should be excluded.

Isolated damage to the uterus outside the period of pregnancy, as well as the fallopian tubes and ovaries, is rare, since the internal genital organs are protected from external influences by the pubic bones. Sometimes, with a closed abdominal injury, ruptures of cystic formations of the uterine appendages (ovarian cysts, hydrosalpinx) are observed.

Closed trauma to the abdomen and uterus during early pregnancy often leads to abortion. The clinical picture in case of spontaneous abortion (started abortion, ongoing abortion, incomplete abortion) is manifested by aching or cramping pains in the lower abdomen and bleeding of varying intensity from the genital tract. Significant blood loss is accompanied by symptoms of increasing anemia: general weakness, pallor of the skin, tachycardia, arterial hypotension.

In late pregnancy, the uterus occupies a significant part of the abdominal cavity and is often the only internal organ that is damaged during a closed abdominal injury. As a result of a gunshot, bullet or shrapnel wound, blunt trauma or exposure to a shock wave of an explosion, damage to the uterus with termination of pregnancy is observed: detachment of a normally located placenta, uterine rupture, intrauterine fetal death, spontaneous abortion and premature birth.

Premature detachment of a normally located placenta is characterized by pain in the abdomen, tension and local tenderness of the uterus during its palpation, symptoms of increasing anemia, the appearance of bloody discharge from the genital tract. Depending on the area of ​​placental abruption, signs of intrauterine hypoxia of the fetus or its death are revealed. There may be a violation of blood coagulation as a result of the development of an acute form of disseminated intravascular coagulation (DIC).

The main signs of uterine rupture are abdominal pain, severe pain on palpation of the abdomen and uterus, symptoms of peritoneal irritation, signs of acutely increasing anemization, hypoxia, or intrauterine death of the fetus.

Simultaneous trauma to the external and internal genital organs occurs in 5% of the total number of genital injuries. It is observed in case of gunshot wounds of the pelvis and lower abdomen, exposure to the impulse of the shock wave of the explosion, falling from a height, road accidents.

Stab and cut wounds, as well as lacerations of the vulva, perineum and vagina are manifested by external bleeding. With closed fractures of the pelvic bones, secondary damage to the walls of the vagina by bone fragments is observed with the formation of hematomas and bruises, with their subsequent spread to the area of ​​the external genital organs.

Diagnosis of wounds and closed injuries of the external and internal genitalia is based on the data of a bimanual examination, examination of the vaginal walls in the mirrors, and an assessment of the general condition of the victim.

Guidelines for military surgery

Name:

They develop as a result of falls, especially on sharp and piercing objects, during intercourse, when hard and sharp objects, instruments (bougie, metal catheters, dilators, etc.) are introduced into the vagina and uterine cavity.

Types of genital trauma

In the practice of obstetrics and gynecology, damage to the genital organs outside the birth act is observed quite infrequently. They are classified as follows:

breaks during sexual intercourse;

damage caused by foreign bodies in the genital tract;

injury to the external genitalia and vagina of a domestic and industrial nature, caused by any sharp object;

bruises of the genitals, crush;

stab, cut and gunshot wounds of the genital organs; injuries due to medical practice.

Symptoms of genital trauma

Injury to the external genitalia is manifested by bleeding, the formation of a hematoma, often extensive, in the region of the labia majora and labia minora, in the vaginal region. If the clitoris is damaged, where there is an extensive vascular network, bleeding can be very profuse.

Treatment of genital injuries

Regardless of the cause of the damage, a thorough examination in a hospital is required to determine its volume, which includes, along with the initial examination, special methods (rectoscopy, cystoscopy, radiography, ultrasonography and NMR, etc.).

Treatment of genital injuries is usually surgical. It consists in careful treatment of the wound, stopping bleeding by ligation of vessels or with the help of tamponade. Less often, suturing is performed on the gap (if the condition of a fresh “uncontaminated” wound is observed). For injuries penetrating the vaginal fornix, a laparotomy is indicated. At the same time, anti-shock measures are performed, tetanus toxoid is administered, and the inflammatory process is prevented and treated.

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Urgent conditions in gynecology can be divided into five groups.

1. Internal bleeding.
2. External bleeding.
3. Inflammatory diseases of the female genital organs.
4. Twisting of the tubes, ovarian cysts, appendages and their tumors.
5. Damage to the female genital organs.

Internal bleeding

An ectopic pregnancy occupies a large place in internal bleeding. It is the most common cause of "acute abdomen" in gynecology and can occur in three ways: tubal abortion, tubal rupture, undisturbed tubal pregnancy.

tubal abortion

With this pathology, a fertilized egg is implanted in the mucous membrane of the ampullar part of the tube. With the growth of the fetus, irritation of the mucous membrane occurs, which causes peristaltic contraction of the tube and pushing the fetus into the abdominal cavity. Bleeding and blood loss are minor. A woman experiences pain in the lower abdomen, dizziness, weakness. At the same time, she notes the irradiation of pain in the shoulder girdle and lateral surfaces of the neck.

There may be bloody discharge from the vagina. A delay in menstruation for a period of 6 to 8 weeks is typical. On examination, pallor of the skin and mucous tubes is noted. Tachycardia. Slight drop in blood pressure.

Soreness on palpation of the lower abdomen, aggravated by percussion and light palpation. The phenomenon of moving dullness may be noted. On vaginal examination, an increase in the uterus is noted and spotting is found. In some patients, a protrusion of any arch can be determined.

pipe rupture

When a fertilized egg is implanted in the middle part of the tube or its neck, its growth leads to a rupture of the tube, which is characterized by the following clinical manifestations:

• sudden onset pain in the lower abdomen with irradiation to the epigastric region and shoulder girdle;
• pallor, cold sweat, pointed facial features, shallow breathing, nausea, vomiting;
• frequent pulse of poor filling, drop in blood pressure, protective tension of the muscles of the anterior abdominal wall;
• pain when the cervix is ​​displaced.

An undisturbed tubal pregnancy is characterized by a delay of menstruation for 68 weeks and vague pain in the lower abdomen.

Ovarian apoplexy (spontaneous rupture) is more common in girls and young women in the form of a rupture of the corpus luteum before the release of the egg into the free abdominal cavity. The disease begins with the appearance of sudden sharp pains in one of the halves of the lower abdomen. Patients report a feeling of lightheadedness, sometimes reaching fainting. They complain of chilliness, thirst, flickering in the eyes, dizziness

Blood loss is usually minor. The condition is satisfactory. The pulse is somewhat quickened. The abdomen is soft, painful on palpation in the lower part.

In the differential diagnosis of internal bleeding of genital origin, one should also think about bleeding from a torn pregnant rudimentary uterine horn, ruptures of the fibroid membrane of its wall and endometrial cysts.

The emergency physician should remember that even a slight suspicion of internal bleeding of genital origin requires immediate referral of the patient to a gynecological hospital. Before transportation, it is necessary to put cold on the stomach, intravenously inject 10.0 ml of a 10% solution of calcium gluconate, 4 ml of a 1% solution of vikasol. Transportation on the board in a horizontal position with a slightly raised foot end.

External bleeding

Here, incomplete abortion should be put in the first place. If there is a delay with referral to the gynecological hospital on duty, then the patient develops a clinical picture of acute anemia, hemorrhagic shock. Diagnosis presents no difficulty.

Emergency assistance during transportation consists in replenishing the BCC by conducting infusion therapy. Immediate hospitalization in a gynecological hospital on duty.

In practice, there are also the following types of external bleeding: juvenile and climacteric, bleeding from submucosal fibroids and progressive cervical carcinomas. Patients with such bleeding need a similar
help.

Inflammatory diseases of the female genital organs

The life-threatening inflammatory processes in the pelvis of a woman include pyosalpinx and pyoovar, as well as an erupted tubo-ovarian abscess. Due to the development of peritonitis, the clinical picture of an "acute abdomen" quickly arises. Diagnosis does not present any difficulties, since most patients have all the signs of peritonitis, and in the anamnesis they constantly emphasize recurring inflammatory diseases of the appendages.

Local symptoms can be very pronounced, including peritoneal phenomena with gonorrhoid infection. Along with severe pain in the lower abdomen, there is a delay in stool and gases, as well as an uncontrollable urge to urinate. The abdomen is enlarged and tense. Due to the severe pain during palpation and the pronounced protective tension of the muscles of the anterior abdominal wall, it is difficult to establish pathological manifestations.

It is very difficult to distinguish acute appendicitis from adnexitis. The first is evidenced by more one-sided findings: an indefinite onset of the disease with nausea, vomiting and epigastric pain (Kocher's symptom).

The onset of illness with high fever, chills, and back pain usually near the onset of menstruation indicates acute adnexitis. Moreover, pronounced soreness is detected directly above the symphysis. Over time, it decreases. In acute appendicitis, the maximum pain on palpation is detected in the right iliac region. Here pronounced symptoms of irritation of the peritoneum are also recorded.

An acute picture of the disease with signs of peritonitis can also be observed as a result of infection of the tumor of the uterus or its appendages, with twisting of the legs of the ovarian cyst or its tumor. Usually, adnexitis is preceded by a cold and a long gynecological history.

All patients with acute inflammatory diseases of the female genital organs and the clinical picture of "acute abdomen" need emergency hospitalization in a gynecological hospital on duty.

Before transportation, you should put cold on the stomach, put the patient on a shield and a stretcher.

If the patient has signs of shock (collapse), it is necessary to administer intramuscularly cardiac and respiratory analeptics (2 ml of a 10% caffeine solution, 2 ml of cordiamine), and in case of a pronounced serious condition, establish an intravenous infusion of 400 ml of polyglucin (slowly, drip).

Torsion of the tubes, ovarian cysts, adnexa and their tumors

Very often, the picture of an "acute abdomen" is caused by twisting of the pedicle of an ovarian tumor cyst, much less often - by a twisting of the ovary or tube. According to the literature, in 15-30% of patients with ovarian tumors, there is a picture of more or less pronounced torsion of its legs. Even in an unchanged ovary, torsion of its legs can occur, followed by necrosis. It is especially difficult to make such a diagnosis in girls. The torsion of the pedicle of the tumor, respectively, of the organ, occurs due to external influences, such as, for example, with a sudden change in body position.

Clinical signs are acute. Their severity and intensity depend on how quickly and completely the blood supply in the leg is interrupted. Twisting is accompanied by severe cramping pains in the lower abdomen, sometimes the pains are so severe that shock occurs. Through the abdominal wall it is possible to probe only a significant size of the cyst (tumor).

There are cases in which there is a gradual increase in pain in the lower abdomen and the volume of the tumor increases slowly. Here, when the pedicle is twisted, only the lumen of the vein with its delicate walls is blocked, and the arterial blood supply continues to be carried out. With a sudden overlap of the lumens of the vein and artery (torsion of the leg by 360), paroxysmal, mainly in the form of colic, pain in the lower abdomen with nausea, vomiting and collapse occurs.

Against this background, a clinic of bacterial-toxic peritonitis may develop. There is a pronounced tension of the anterior abdominal wall and here - a positive symptom of Shchetkin - Blumberg. There are cases in which severe septic shock, which complicates torsion of the tubes, appendages and their tumors, very quickly led to a tragic outcome.

When conducting differential diagnosis, the following nosological forms should be excluded: acute intestinal obstruction (strangulation forms), acute appendicitis, opened pyosalpinx, intussusception, perforation of the duodenal ulcer and stomach.

In rare cases, torsion of subserous uterine fibroids may occur, with its necrosis occurring. The clinical picture is identical to that of ovarian cyst torsion.

Damage to the female genital organs

Life-threatening injuries of the female genital organs are primarily the consequences of interventions in the uterine cavity. This includes manipulations, for example, with a curette during abortion, as well as during diagnostic curettage during uterine bleeding. Any perforation of the uterus during abortion and after criminal interventions requires immediate laparotomy.

Since the external genital fissure and vagina are reliably protected by the pelvic bone ring and the reflex protective movements of the thigh muscles, their damage occurs very rarely. If they do occur, they are usually the result of sexual intercourse, rape, and direct injury.

During intercourse, damage occurs due to the application of more effort than necessary, with a rigid hymen and infantile genitalia, or with anomalies in the development of the female external genital organs. Bleeding during defloration can be especially severe if there are violations in the blood coagulation system.

Bleeding is especially severe with open injuries of the clitoris.

Stab wounds belong to typical traumatic injuries of the external genitalia in girls and women. With this kind of injury, the vagina, colon, urethra, bladder, rectum can be damaged. It is very important to study the course of the wound channel. Significant blood loss and stress lead to the development of shock.

Treatment of bleeding due to sexual intercourse primarily involves the use of tamponade.

To exclude damage to other organs, the bladder, urethra, posterior vaginal fornix, and rectum should be carefully examined.

In case of open injuries of the female genital organs, it is necessary to toilet the wound - treat the skin in its circumference with alcohol and iodine. Then apply an aseptic bandage to the wound.

In the presence of a pronounced pain syndrome, intramuscularly administer analgesics (2 ml of a 5% solution of analgin, 1-2 ml of a 2% solution of promedol).

Transportation to the gynecological hospital on duty on a shield and a stretcher on an emergency basis.

Buyanov V.M., Nesterenko Yu.A.

How are traumatic injuries of the female genital organs classified?

Foreign bodies.

Fresh wounds and damage to the genital organs:

Fresh injuries, depending on sexual intercourse;

Fresh injuries, not dependent on sexual intercourse;

Injuries caused by cutting and stabbing objects and firearms;

Burns.

Old injuries of the genital organs and their cicatricial changes:

Injuries (ruptures) of the perineum and vagina;

Uterine damage. Urogenital and intestinal-genitourinary fistulas.

What are the most common complaints of foreign body ingestion?

The most common complaints are pain, leucorrhoea (usually fetid), spotting.

Under what circumstances can foreign bodies enter the vagina?

Foreign bodies can get into the vagina in the following cases:

When providing patient medical care (uterine rings, pessaries, gauze and cotton swabs);

When using contraceptives - male and female condoms;

With the introduction of various objects into the vagina for the purpose of abortion, masturbation, etc.

How is the recognition of foreign bodies in the vagina?

Recognition of foreign bodies in the vagina is based on a gynecological examination using mirrors, as well as a digital examination and does not present difficulties.

What are the main principles of treatment?

Treatment consists in removing the foreign body, prescribing weakly disinfecting douches with a solution of potassium permanganate 1:4000-1:6000 or other antiseptics.

When do fresh wounds and injuries of the genital organs most often occur?

Fresh injuries and damage to the genital organs most often occur during childbirth or during induced abortion, so they are presented in the course "Obstetrics", but the urogenital organs can be damaged during intercourse, gynecological operations (Fig. 14.1) and violent acts.

Rice. 14.1.Perforation of the uterus: A - curette; B - with the introduction of the IUD

What is the damage to the hymen during the first sexual intercourse called?

Damage to the hymen occurs, as a rule, during the first sexual intercourse - defloration (defloration). Tears of the edges of the hymen in this case are shallow and are accompanied by minor bleeding.

What are the causes of its pathological rupture?

Sometimes during the first sexual intercourse, the rupture of the hymen reaches its base and is accompanied by profuse bleeding. The reasons for such a pathological rupture are excessive strength (rigidity) of the hymen, its fleshiness, underdevelopment of the genital organs, as well as excessive physical impact during rudeness and violence.

Damage to the vagina occurs due to underdevelopment, a decrease in elasticity, or excessive softening of the walls.

Where does vaginal rupture usually occur?

The vaginal walls are usually torn in the upper third in the region of the posterior or one of the lateral arches. With a deep rupture of the lateral wall of the vagina, the pelvic tissue is exposed. It is extremely rare that a rupture of the vaginal fornix is ​​accompanied by a violation of the integrity of the peritoneum lining the recto-uterine cavity (Douglas space). In such cases, prolapse of intestinal loops may occur.

What are the symptoms of genital ruptures?

Symptoms of genital ruptures in connection with sexual intercourse are pain and bleeding, sometimes very profuse. Causes of bleeding - torn veins, cavernous lacunae, arterial branches.

What is the diagnosis of such gaps based on?

Diagnosis of ruptures is not difficult if we take into account the characteristic anamnesis and the availability of damaged organs for examination.

What is the tactics of surgical treatment in infected and non-infected cases?

Treatment in non-infected cases is surgical: ligate bleeding vessels and suture the edges of torn tissues. If the bleeding vessel is not found, then a submerged catgut suture is applied to the bleeding area. If a fresh rupture of the vaginal wall penetrates deeply, then the wound must be sutured in layers and sequentially. In case of damage to the intestines, abdominal surgery is indicated.

In infected cases, it should be limited only to ligation of bleeding vessels or stitching of the corresponding area without suturing the edges of the wound; wound surfaces are treated with antiseptic solutions and infiltrated with antibiotics.

What is the prognosis with proper and timely treatment?

The prognosis with proper and timely treatment is favorable.

What can be attributed to accidental injuries during medical manipulations?

This group includes injuries caused during various medical procedures: with a deep expansion of the cervical canal with metal dilators, accidental injuries of the bladder, ureter, uterus during operations.

What is the most common cause of blunt trauma to the external genitalia?

Blunt trauma occurs due to the impact of blunt objects (bruise) or indirectly (in case of damage to the bone pelvis, with a gunshot wound, etc.). As a result of such injuries, a hematoma most often develops, which, depending on the site of the injury, can form in the vulva, perineum, or vagina.

What are the symptoms of a vulvar hematoma?

Pain appears at the site of injury, sometimes unbearable; urination becomes frequent and painful. With the spread of the hematoma in the peri-intestinal and peri-vaginal tissue, tenesmus, difficulty in urination and defecation appear. The swelling at the site of the bruise acquires a bluish-black or bluish-red color. When the hematoma spreads through the fiber, the phenomena of acute anemia come first, despite the absence of external bleeding.

What is the diagnosis of vulvar hematoma based on?

Hematoma is recognized by examining the external genital organs and a digital examination of the vagina.

What are the basic principles of treatment of vulvar hematoma?

First of all, treatment should be aimed at stopping bleeding, at maintaining the integrity of the hematoma integument in order to avoid infection, and at reducing pain. For this purpose, rest is prescribed,

painkillers, ice pack. If the hematoma grows along with the symptoms of anemia, then it is opened with a wide medial incision, clots are removed, bleeding vessels are stitched. The hematoma cavity is drained. Antibiotics are prescribed prophylactically. With significant blood loss, the volume of the BCC is replenished.

Why do clitoral injuries require emergency surgical treatment?

Injuries to the clitoris due to the saturation of this organ with blood vessels are extremely dangerous, as they are accompanied by severe bleeding, and therefore require emergency surgical treatment.

What is the surgical treatment of clitoral injuries?

Treatment consists of applying hemostatic sutures.

How is a vaginal injury diagnosed?

The diagnosis is established after examination of the vagina with the help of mirrors.

What is the tactics of surgical treatment of wounds of the vagina?

Treatment consists of primary surgical debridement and suturing. In case of violation of the integrity of the peritoneum, bladder and intestines, abdominal dissection is indicated.

What are the main causes of burns of the vulva, vagina and cervix?

Burns of the vulva, vagina and cervix appear as a result of vaginal douching with hot water or an overdose of disinfectants.

What is the treatment for genital burns?

Treatment does not differ from the methods generally accepted in surgery for body burns.

When do cervical ruptures most often occur?

The cervix is ​​most often damaged during childbirth and less commonly during abortion.

What can cause scarring of the cervix?

Cicatricial deformity of the cervix occurs in cases where the ruptures were not sutured or when they were healed by secondary intention (Fig. 14.2).

Rice. 14.2.Cicatricial deformity of the cervix: 1 - after unilateral rupture; 2 - bilateral; 3 - multiple (star scar)

What symptoms can occur with a deformity of the cervix?

Symptoms of old cervical ruptures are leucorrhea, infertility, miscarriage, menstrual irregularities, pain in the lower abdomen and lumbar region.

What are the "generally accepted" surgical methods for the treatment of scarring of the cervix?

These methods include the Emmett operation, cone-shaped amputation according to Sturmdorf and wedge-shaped amputation according to Schroeder, high amputation of the cervix, cervical plastic by the method of dissection according to V.I. Yeltsov-Strelkov.

What is the advantage of surgical treatment of cicatricial deformity of the cervix according to the method of V.I. Yeltsov-Strelkov?

This reconstructive plastic surgery allows, along with the removal of all scar tissue, to completely restore the shape and function of the cervical canal and cervix (see Chapter 6).

What is a fistula?

fistula (fistula) called an artificial passage formed between two adjacent hollow organs or hollow organs and the outer skin.

What fistulas are distinguished?

Distinguish:

Vesical fistulas: vesico-vaginal, vesico-uterine, vesico-adnexal;

Ureteral fistulas: ureteral, ureteral-moisture, uretero-uterine;

Urethrovaginal and urethrovesical-vaginal fistulas;

Combined fistulas: urinary, urinary.

Complex urogenital fistulas (Fig. 14.3).

Rice. 14.3.Genitourinary fistulas: 1 - vesicovaginal; 2-vesicouterine (cervical); 3 - urethrovaginal; 4 - ureterovaginal

What are the main causes of fistulas?

The causes of fistulas are varied. These include:

Birth injury;

Injury inflicted on the genitourinary organs and intestines during operations and manipulations;

Anomalies of development;

Malignant tumors in the stage of tumor decay;

radiation damage;

A breakthrough of pus or other pathological product from the uterine appendages into the urinary organs, vagina or intestines;

Tuberculous process in the lower intestine;

Accidental injuries with damage to the walls of each of the organs adjacent to each other.

What fistulas are most common?

Genitourinary fistulas are much more common than enterogenital fistulas due to the fact that the urethra and isthmus of the bladder are located behind the pubic arch, are easily pressed against it by the fetal head inserted into the small pelvis, while the sigmoid and rectum are in more favorable conditions, since they are protected from fetal head pressure.

What are the main symptoms of fistulas?

The main symptoms of a fistula include:

Urinary and fecal incontinence;

Inflammatory processes in the external genitalia, vagina, bladder, in the overlying parts of the urinary system - the ureter, renal pelvis, kidney parenchyma;

With fistulous openings between the cavity of the abscess (pyosalpinx, abscess of the recto-uterine cavity, etc.) and the vagina; pus flows out of the latter.

What is the diagnosis of fistula based on?

Already when collecting an anamnesis, it is possible to establish the presence of a fistula and its nature, localization, size.

If urine is continuously leaking, but spontaneous urination is also possible, a ureterovaginal or very small vesicovaginal fistula should be assumed.

A fistula with a large diameter is also detected with a simple examination using mirrors or a two-handed vaginal examination. You can apply the probing of the fistulous passage through the vagina, the test with the filling of the bladder. For this, about 200 ml of a sterile coloring disinfectant is injected (rivanol 1:1000, methylene blue 1:2000, potassium permanganate 1:1000). When examining the vagina with the help of mirrors, fluid leakage from the fistulous opening is detected, and its location and size are determined. The presence of a fistula, its location and size can be determined using cystoscopy and chromocystoscopy. In the presence of combined fistulas, it is possible to use an X-ray examination using water-soluble contrast agents (fistulography).

What method of treatment is applicable for this pathology?

Treatment is only surgical (Fig. 14.4). The operation is carried out not earlier than in 4-6 months. after fistula formation. The principle of the operation of suturing the urinary fistula is to separate the fistula of the vaginal wall from the wall of the bladder and give it mobility.

Rice. 14.4. Options for suturing the intestinal-vaginal fistula: I - with dissection of the external pharynx: a - incision line (1 - external pharynx; 2 - fistula); b - the muscular membrane is highlighted; c - the first row of sutures (musculoskeletal); g - the second row of sutures (on the mucous membrane); II - without dissection of the external pharynx: a - incision line (1), fistula (2); b - the first row of sutures (musculoskeletal); in - the first row of seams, covered with a flap of the back row

After that, the edges of the wound are connected with interrupted, separate sutures in such a way that the ligatures pass transversely through the muscular layer of the bladder. The second row of interrupted sutures is placed on the tissue of the bladder, and the third - on the wall of the vagina. In the postoperative period, a permanent catheter is inserted, the bladder is washed with solutions of antiseptics, antibiotics.

Fecal fistulas are sutured through the vagina - the edges of the fistulous opening are excised and layered sutures are applied to the edges of the fistulous passage without piercing the intestinal mucosa.

What is the prevention of the occurrence of fistulas of the female genital organs?

Prevention consists in the proper organization of obstetric care and proper management of childbirth, timely treatment of patients with tumor processes in the genital organs, careful surgery on the pelvic organs and qualified management of patients and puerperas in the postoperative and postpartum periods.

What are the features of female genital trauma in girls?

The features of injuries in girls are injuries of the vulva and vagina due to falling on sharp, cutting and stabbing objects, as well as burn injuries due to the carelessness of parents (boiling water, open fire).

What are the features of treatment tactics in girls?

Features of medical care for girls are effective pain relief, prevention of shock, and closure of tears with atraumatic needles.

Damage to the genital organs can be divided by location (external genital organs, vagina and uterus, urogenital and enterogenital fistulas) and by causes (birth, abortion, bruises, strokes, falls, sexual intercourse).

Damage to the external genitalia, perineum and vagina occurs with bruises, falls, with rough sexual intercourse, as well as in the presence of scars, senile atrophy, underdevelopment of the female genital organs. More often, hematomas and open wounds are formed. In case of damage to the vessels, massive bleeding can occur, especially when they are localized in the clitoris. Stab, cut and gunshot wounds of the female genital organs are rare, they can be superficial and deep, penetrating into the retroperitoneal space, and combined with damage to adjacent organs.

During sexual intercourse, especially the first, there may be injuries to the labia, hymen, vaginal walls (often in the posterior fornix), damage to the rectum, bladder, and even penetration into the abdominal cavity. In the latter situation, the intestines may be damaged, peritonitis and sepsis may develop.

The clinical picture is manifested by various symptoms. Bleeding, pain, sometimes incontinence of urine, feces, development of infection are more often observed. The resulting hematomas can progressively increase, capturing adjacent tissues and organs. They can spread to the paravaginal tissue, perirenal area and other places.

When providing first aid: apply cold (ice pack) to the site of injury, in case of bleeding and hematomas, it is necessary to carry out a tight tamponade of the vagina or apply a tight bandage, urgently take the patient to the hospital. If the blood loss is massive, then intravenous administration of solutions is mandatory for the purpose of replacement therapy and the prevention of hemorrhagic shock. If necessary, painkillers.

Treatment in each case is determined by the nature of the damage and symptoms. Wounds are sutured with separate sutures, progressive hematomas are opened to find and bandage bleeding areas. In case of damage to adjacent organs, they are restored. In some cases, surgical interventions are performed jointly by an obstetrician-gynecologist and a surgeon. If damage to the abdominal organs is suspected, an urgent laparotomy is performed, followed by suturing or resection of the intestine, suturing the bladder, etc.

Damage to the uterus occurs more often during abortion or childbirth. Cervical ruptures are observed during childbirth, expansion of the cervical canal with Hegar dilators.

Damage to the body of the uterus can be produced by a probe, dilator, curette, abortsang, and other objects (when performing a criminal abortion). During an artificial abortion, perforation of the uterus is performed when the position of the uterus is not known before the start of the operation, with forced execution, in case of inferiority of the walls of the uterus in the postpartum period, during inflammatory processes, etc.

Clinical symptoms of uterine perforation can be pain and bleeding, possibly the formation of hematomas. If the wound penetrates the abdominal cavity, then the intestines, bladder and other organs may be damaged, sharp pains and even shock may occur.

At the stage of first aid and preoperative preparation, bed rest, cold on the lower abdomen, infusion therapy, anesthesia are mandatory.

Treatment consists of urgent laparotomy and suturing of the opening on the uterus. In case of large damage, infection, the uterus is removed. In case of damage to the abdominal organs, an appropriate surgical intervention is performed on the intestines, bladder, etc. If the uterus is perforated with a probe, conservative management is possible (bed rest, careful observation, antibiotic therapy).

With ruptures of the cervix, it is sutured or plastic surgery is performed.

Urinogenital and enterogenital fistulas can occur during pathological childbirth, gynecological operations, radiation therapy of malignant neoplasms. Genitourinary fistulas can be caused by damage to the lower (urethra), middle (bottom of the bladder) and upper (ureter) sections of the urinary tract. Gastrointestinal fistulas occur with ruptures of the perineum of the III degree or injuries of the rectum in the case of using obstetric forceps, amniotomy.

The clinical picture is characterized by urinary incontinence with genitourinary fistulas, gases and feces - with intestinal-genital. When examining in the mirrors, fistulas are detected quite easily; to clarify the diagnosis, the method of cystoscopy can be used.

Surgical treatment - suturing fistulous openings using special techniques. Small fistulas with proper care can sometimes close on their own. Care includes hygiene of the genital organs, treatment of the skin of the external genital organs and the mucous membrane of the vagina with vaseline or other oil, synthomycin emulsion.

Prevention is based on the correct management of childbirth (see the textbook "Obstetrics"), compliance with the technique of gynecological operations and irradiation regimens for malignant tumors.

ECTOPIC PREGNANCY

An ectopic pregnancy develops when a fertilized egg implants outside the uterus. When the ovum is localized in unusual places in the uterus, the pregnancy is called uterine with atypical (abnormal) implantation of the ovum. These conditions are accompanied by bleeding and the clinical picture of "acute abdomen" and require emergency care. Both concepts are united by the name "ectopic pregnancy".

The frequency of ectopic pregnancy is continuously increasing. Over the past 2-3 decades, it has increased in a number of countries by 4-6 times in relation to both the number of births and the total number of pregnancies. Improving the methods of timely diagnosis and the provision of urgent care has significantly reduced the frequency of deaths.

The pathogenesis of the disease is reduced to a violation of the transport of a fertilized egg and the pathology of implantation of the fetal egg. The causes and risk factors of ectopic pregnancy include: 1) contributing to functional disorders of the genital organs - the use of hormonal drugs for therapeutic and contraceptive purposes (estrogenic and progestogen drugs, synthetic progestins, stimulation of ovulation and pregnancy, etc.), history of infertility, ectopic pregnancy in history, infantilism, various endocrine pathologies; 2) contributing to the anatomical pathology of the genital organs - inflammatory diseases of the fallopian tubes and other genital organs of various etiologies, tumors and tumor-like diseases of the genitals, malformations, abortions, intrauterine interventions; 3) other causes - intrauterine contraceptives, previous surgical interventions on the pelvic and abdominal organs, endometriosis.

Classification of ectopic pregnancy by localization:

Ectopic pregnancy - tubal, ovarian, interligamentous, abdominal;

Abnormal variants of uterine pregnancy - cervical, interstitial, pregnancy in the rudimentary horn of the uterus.

Clinically, with all types of ectopic pregnancy, there are: progressive, interrupted, interrupted.

Emergency measures require situations due to interrupted or interrupted pregnancy.

Tubal pregnancy is the most common (90-98%) among ectopic ones. The clinical picture of tubal pregnancy depends on the location of the fetal egg (ampullar, interstitial, isthmic), the type of termination (tubal miscarriage, rupture of the tube) and the term.

With a rupture of the fallopian tube, there are always symptoms of internal bleeding of varying severity: pathological blood loss, massive blood loss syndrome, hemorrhagic shock. At the same time, symptoms of peritoneal irritation develop: bloating, soreness, tension of the anterior abdominal wall, peritoneal symptoms. Intra-abdominal bleeding and symptoms of peritoneal irritation are interrelated. With their severity, it is often not possible to palpate the uterus and appendages during vaginal examination, which in such situations should not be sought.

The rupture of the fetus during tubal pregnancy is always accompanied by a sharp pain in the abdomen, which is caused both by the rupture of the tube itself and by irritation of the peritoneum with blood pouring into it. The pain may be severe or less intense, but is always observed with an interrupted tubal pregnancy. Often, a severe attack of pain at the time of pipe rupture is preceded by less intense cramping pain. They are associated with tubal peristalsis ("tubal colic") due to hemorrhage into the ovum before the rupture of the tube. A similar phenomenon occurs with a preparing tubal miscarriage. Sometimes at the time of an intense pain attack there is a loss of consciousness. Thus, classically, the rupture of the fetus in the tube is accompanied by loss of consciousness, fainting and general weakness as a result of internal bleeding and pain symptoms.

An interrupted tubal pregnancy is characterized by changes in the blood: a decrease in the number of erythrocytes, the amount of hemoglobin, hematocrit; often elevated ESR, slight leukocytosis.

These phenomena may not be with a rupture of the pipe or a tubal miscarriage at an early stage of development of the fetal egg (2-3 weeks from the moment of implantation, often before the next menstruation).

Ovarian pregnancy is quite rare. In recent years, an increase in its frequency has been noted, which is associated with some types of intrauterine and oral hormonal contraception. The fertilized egg can be localized on the surface of the ovary or inside the follicle. Rupture of the fetus during ovarian pregnancy is accompanied by symptoms of internal bleeding.

Interligamentous pregnancy deserves special attention, primarily because it reaches long terms. With it, the fetal egg, attached to the tube, develops to the side between the sheets of the broad ligament. An intraligamentary ectopic pregnancy may not clinically differ from the uterine one until relatively long periods (3-5 months). More often, the diagnosis of interligamentous pregnancy is established after its interruption and surgical intervention due to heavy bleeding, which is always observed when the broad ligament is ruptured.

The abdominal form of ectopic pregnancy is considered possible. It is primary (when the egg is implanted on the peritoneum, it is primary) and secondary (the fetal egg is attached to the peritoneum for the second time after a tubal miscarriage). A fertilized egg is implanted more often in areas free of intestinal peristalsis (behind the uterus, in the area of ​​the liver and spleen). In the process of development, various organs of the abdominal cavity (intestine, omentum) are involved in it. Diagnosis and surgical treatment of this form of pregnancy is very difficult.

Pregnancy in the rudimentary horn of the uterus occurs when there is a rudimentary uterus, the cavity of which communicates with the tube and does not have an exit to the vagina. At the same time, the mucous and muscular walls of the rudimentary horn are not developed, and they do not allow the pregnancy to be carried to term due to the rupture of the horn at 8-16 weeks. Until this period, in clinical terms, pregnancy proceeds like a uterine one, often with pain, which leads to hospitalization and therapy, as in case of miscarriage. When a rudimentary uterine horn with a fetal egg ruptures, intense bleeding and the rapid development of internal peritoneal symptoms are noted.

Ectopic pregnancy in the interstitial section of the tube proceeds almost the same as in the rudimentary horn of the uterus. It develops until a later date (3-5 months) and ends with an external rupture of the fetus. At the same time, the syndrome of massive blood loss or hemorrhagic shock in combination with peritoneal shock is rapidly growing.

Cervical pregnancy in the clinical course refers to the variants of ectopic uterine pregnancy. In the early stages, it is asymptomatic, with signs similar to uterine pregnancy. Then there are spotting, often "contact", and patients are hospitalized with a diagnosis of "started abortion". On examination, a flask-shaped increase in the cervix is ​​determined with a small body of the uterus, which is often smaller than the "pregnant" cervix. With this form, there is a great danger of profuse bleeding that threatens the woman's life.

Progressive ectopic pregnancy in all variants of both ectopic and uterine localization in the early stages may not be clinically accompanied by any specific symptoms. The anamnesis is distinguished by the presence of one or more risk factors (inflammatory processes, contraceptive options, endocrine pathology, etc.). Delayed menstruation and subjective signs of pregnancy (taste perversion, nausea, vomiting, etc.) are characteristic. The mucous membrane of the vagina and cervix, as in uterine pregnancy, is cyanotic in color, the cervix is ​​softened to a lesser extent. The body of the uterus is slightly enlarged, but less than in the corresponding period during uterine pregnancy. Symptoms of Hegar, Piskachek and others characteristic of uterine pregnancy are either mild or not defined.

Depending on the location of the fetal egg, deformities of the uterus or tumor-like formations can be observed in different places: in the ovaries - in the area of ​​​​the appendages; between the leaves of the broad ligament - on the side of the uterus; in the rudimentary horn - next to the body of the uterus; in the interstitial part of the tube - the asymmetric body of the uterus; in the cervix - a flask-shaped neck; in the abdominal cavity - in its various places. The size of tumor-like formations and the degree of deformation of the uterine body depend on the timing of ectopic pregnancy. An important clinical sign of ectopic pregnancy is the lag in the size of the uterus from the timing of the intended pregnancy with an increase in the size of tumor-like formations, determined at the sites of localization of the fetal egg during ectopic pregnancy of various options.

Smearing bloody uterine discharge often (up to 50 - 70%) occur during ectopic pregnancy of various localization. Its characteristic feature is the lack of effectiveness of bleeding therapy, including hormonal methods of hemostasis.

In the diagnosis and during the differential diagnosis of ectopic pregnancy, along with the data of anamnesis and clinical symptoms, special attention is paid to special research methods.

Biological, serological and immunological methods make it possible to determine the levels of human chorionic gonadotropin, estrogenic compounds and progesterone in urine and blood. These methods have a high diagnostic value.

Ultrasound in ectopic pregnancy occupies a special place. Transabdominal ultrasound allows you to determine or exclude uterine and ectopic pregnancy, normal or abnormal development of the uterine. However, at an earlier time (up to 1 week), the presence of uterine and ectopic pregnancy can only be determined using transvaginal echography - a quick, widely available and highly effective (90 - 95% of cases) method for diagnosing ectopic pregnancy. It is believed that the introduction of ultrasound allows excluding invasive techniques (culdoscopy, laparoscopy, laparotomy, and even puncture of the abdominal cavity through the posterior fornix) from the practice of diagnosing ectopic pregnancy.

The puncture of the abdominal cavity through the posterior fornix retains its relevance and significance, allowing the diagnosis of interrupted and interrupted ectopic pregnancy in various conditions. In most cases, patients with ectopic pregnancy seek help after its termination. Clinical symptoms in such cases and positive results of culdocentesis (detection of non-clotting blood) allow you to quickly make a decision on the organization and provision of emergency, including surgical, care. However, it is known that abdominal puncture does not reveal a developing ectopic pregnancy. In addition, when puncturing the abdominal cavity, both false positive and false negative results can often be obtained, which provokes the implementation of unnecessary surgical intervention or, conversely, delays its timing when it is indicated.

Laparoscopy in the diagnosis of ectopic pregnancy is a fairly informative method. More often in practice, surgical laparoscopy is used to treat ectopic pregnancy. Indications for diagnostic laparoscopy may be situations where the previously described methods, taking into account complaints and clinical symptoms, do not allow differential diagnosis between ectopic pregnancy and other diseases.

Curettage (curettage) of the uterine mucosa is performed in the absence of symptoms requiring urgent surgical intervention after culdocentesis. Histological examination of scrapings remains a widely used research method in the diagnosis of ectopic pregnancy, its differentiation from uterine pregnancy and uterine abortion. Suspicion of the presence of elements of the fetal egg in the scraping and its confirmation by histological examination are the basis for the diagnosis of incomplete uterine abortion. The absence of elements of the ovum in the scraping from the uterus serves as the basis for additional studies (ultrasound, urine tests), dynamic monitoring.

Differential diagnosis of ectopic pregnancy is carried out with a number of surgical and other gynecological diseases.

Developing ectopic pregnancy often has to be differentiated with the following diseases: the threat and the onset of termination of uterine pregnancy in the early stages; incomplete abortion; dysfunctional uterine bleeding and inflammation of the uterine appendages. Important criteria for the differential diagnosis between these diseases are (along with the data of the anamnesis and the clinical picture) the results of serological and immunological blood tests, ultrasound, urine tests, uterine curettage and scraping histology. According to the indications, trial anti-inflammatory therapy and hormonal hemostasis (estrogen) can be carried out.

Termination of tubal pregnancy by type of tubal abortion is clinically similar to uterine miscarriage. For diagnosis, you can use ultrasound, culdocentesis, curettage of the uterus. The information obtained, together with clinical data, contributes to the correct diagnosis.

When a tube ruptures with pregnancy, intense bleeding is possible and the diagnosis is usually not difficult. Often, peritoneal symptoms may predominate, which requires differential diagnosis with acute surgical diseases (peritonitis, appendicitis, acute cholecystitis, renal colic). Clinical symptoms, combined with the results of blood and urine tests, culdocentesis, allow us to differentiate these conditions. In particularly difficult situations, urgent laparotomy resolves doubts.

Differential diagnosis of ectopic pregnancy in the rudimentary horn of the uterus with the pathology of uterine pregnancy is carried out using ultrasound.

First aid for ectopic pregnancy includes hunger, cold in the lower abdomen, transportation of a woman on a gurney (stretcher) to the operating room (hospital) with a “needle in a vein”. In cervical pregnancy, in case of spotting, vaginal tamponade is carried out during transportation.

The treatment of ectopic pregnancy is generally recognized as surgical intervention. The correct tactic is the simultaneous implementation of surgical intervention with stopping bleeding and resuscitation. Under general anesthesia, a laparotomy is performed and the bleeding site is clamped (bleeding stop), after which the operation can be stopped for intensive resuscitation and, if possible, reinfusion of blood from the abdominal cavity. Until the bleeding stops, the main resuscitation measures are blood transfusion and anesthesia. The use of drugs and infusion of solutions to increase blood pressure can only aggravate the condition.

More often, during tubal pregnancy, a salpingectomy is performed (for women who have performed a reproductive function, and in the absence of conditions for organ-preserving operations), less often - removal of the fetal egg with suturing or plasty of the tube.

With the localization of the fetal egg in the interstitial section of the tube, surgical intervention consists in excising the angle of the uterus.

The operation for ovarian pregnancy consists in resection of the ovary, and in the absence of such an opportunity, adnexectomy.

The operation technique for intraligamentary pregnancy consists in first dissecting the peritoneum of the broad ligament over the hematoma, which is removed along with the fetal egg, and then salpingoectomy is performed.

When the fetal egg is localized in the rudimentary horn of the uterus, it is removed, if possible, while preserving the uterine appendages.

The volume of surgical intervention in abdominal pregnancy is determined only during the operation itself. It may be necessary to remove, along with the fetus, the surrounding tissues of the uterus (parietal peritoneum, intestinal area, omentum and other organs). In this regard, the operation should be performed by a gynecologist and a surgeon.

Surgical treatment of cervical pregnancy consists in the extirpation of the uterus without appendages. In rare cases, with a short-term cervical pregnancy, it can be limited to the removal of the fetal egg, curettage of the bed of the fetus, followed by tamponade in an extended operating room.

In the surgical treatment of ectopic pregnancy, laparotomy is increasingly being replaced by surgical laparoscopy. Its capabilities are constantly expanding, and taking into account minimal traumatization, quick recovery and high efficiency in preserving fertility, this direction is especially promising.

After surgical treatment of ectopic pregnancy, women who need to continue their reproductive function, while maintaining at least one fallopian tube or after performing organ-preserving operations, are shown rehabilitation therapy. The latter should start from the moment of operation and continue for 6 months. It includes a thorough sanitation of the abdominal cavity and the creation of an artificial hydroperitoneum by introducing a sterile fluid (rheopolyglucin) into the abdominal cavity; intensive antibiotic therapy in the postoperative period with a preventive purpose; a course of hydrotubation from the 4th - 5th day after the operation; physiotherapy treatment in the postoperative period; periodically (within 6 months after surgery) courses of physiotherapy, hydrotubation, if necessary, and antibiotic therapy; regulation of the menstrual cycle according to indications; protection from pregnancy for the period of rehabilitation measures.

Conservative treatment of early tubal pregnancy is carried out with methotrexate and citrovar (0.1 mg / kg per day) under dynamic close ultrasound monitoring of the condition of the fetal egg. Its disappearance is explained by resorption or tubal miscarriage. However, at the moment, the feasibility of conservative treatment of ectopic pregnancy has not been definitely established, and it is not carried out in our country.

ovarian apoplexy

Rupture of the ovary in the literature is found under the names "ovarian apoplexy", "ovarian bleeding". The etiology and pathogenesis of ovarian ruptures can be considered insufficiently studied. This pathology accounts for up to 3% or more of all cases of internal bleeding in women. It is observed more often in 20 - 35 years, rarely in the premenopausal period and in girls before the onset of menstruation. In fact, microdamage to the ovaries with slight bloody discharge from them occurs at each ovulation.

With certain exogenous or endogenous influences, "physiological" damage becomes pathological, already referred to as ruptures of the ovary. Various hormonal disorders, inflammatory processes, anomalies in the position of the genital organs, tumors, etc. are considered endogenous factors. Exogenous causes that cause ovarian rupture include abdominal trauma, weight lifting, vaginal examinations, violent sexual intercourse.

Ovarian apoplexy, occurring on all days of the menstrual cycle, most often occurs in its middle, i.e., in the periovulatory period, as well as in the second phase of the cycle, during the period of maturation and functioning of the corpus luteum.

The high frequency of ruptures of the right ovary (2 - 5 times more often than the left) can be explained by its more abundant blood supply (the right ovarian artery departs directly from the aorta, and the left - from the renal artery).

The clinical picture of ovarian bleeding resembles that of an ectopic pregnancy. Against the background of complete health, often in the middle of the night there is a sudden attack of pain in the abdomen, on the right or left. Often, when clarifying the anamnesis, it is possible to find out that this was preceded by tingling pains in one of the inguinal regions, probably associated with the formation of a hematoma in the ovary.

The pain symptom, starting with an attack, develops differently in all patients. Pain that appeared on one side of the lower abdomen radiates to the lower back, genitals or is blurred. Pain symptom, initially caused by rupture of the ovary, later develops due to irritation of the peritoneum by the blood pouring into the abdominal cavity.

Then there are symptoms of irritation of the peritoneum (in 35% of cases). The zone of pain during palpation of the abdomen is determined on both sides and is more intense on one side - in the area of ​​rupture of the ovary. The tension of the abdominal wall, as well as ruptures of the ovaries, is more often observed on the right, as in appendicitis. However, the degree of tension may be weak or not at all pronounced, even with severe pain.

There is a direct relationship between the intensity of bleeding and the phenomena of anemia. Revealed a decrease in the number of red blood cells, hemoglobin levels, hematocrit. Hemodynamic disturbances are always observed: a decrease in blood pressure, an increase in heart rate.

Other symptoms include bloody discharge from the genital tract, sometimes fever, dizziness, and weakness.

Bimanual examination reveals the following data: the uterus is of normal size; its appendages (on the part of apoplexy) are enlarged, painful, especially when displaced; the vaults of the vagina, often posterior, protrude; pain when the cervix is ​​displaced.

Clinical variants are distinguished:

Anemic - with leading symptoms of internal bleeding up to hemorrhagic shock;

Painful (pseudoappendicular) - accompanied along with pain by nausea, vomiting, leukocytosis and fever, symptoms of peritoneal irritation;

Mixed - in which the symptoms of both groups are expressed - anemic and peritoneal.

Classification of ovarian apoplexy according to severity:

I degree - mild - is characterized by a short attack of pain, moderate pain on palpation of the abdomen, nausea with no data on anemization and symptoms of peritoneal irritation;

II degree - medium - severe and prolonged pain, starting with an attack and spreading throughout the abdomen or radiating to other places, weakness, pallor of the skin, fainting, nausea, vomiting, peritoneal symptoms are noted;

III degree - severe - constant sharp pain in the lower abdomen, gradually spreading throughout the abdomen, phenomena of collapse or shock (cold sweat, drop in temperature, lowering blood pressure and tachycardia, cold extremities, pallor), severe symptoms of peritoneal irritation with intestinal paresis or on the contrary, excessive peristalsis.

Along with the data of the anamnesis and the clinical picture, auxiliary methods are used to diagnose the disease: puncture of the abdominal cavity through the fornix, ultrasound, laparoscopy. In differential diagnosis with ectopic pregnancy, urine pregnancy tests for chorionic gonadotropin are performed, with appendicitis - blood tests (leukocytosis, ESR) and thermometry in dynamics.

Treatment of patients with ovarian rupture depends primarily on the intensity of internal bleeding. Conservative management of women with grade I ovarian apoplexy (mild form) is possible in stationary conditions. At the same time, bed rest, cold or the lower part of the abdomen are prescribed with observation and examination in dynamics. Deterioration of the general condition, the appearance or intensification of peritoneal symptoms, an increase in heart rate, a decrease in hemoglobin and the number of red blood cells are the basis for changing tactics and performing surgical intervention.

With II and HI degrees of severity (moderate and severe form), immediately after the diagnosis is established, an operation is performed. Taking into account the condition of patients, resuscitation measures are carried out simultaneously (hemotransfusion, infusion of blood-substituting solutions, etc.).

During surgical treatment, it is necessary to strive to minimize it - to perform an organ-preserving intervention (ovarian resection). In cases of apoplexy in the corpus luteum with rupture of the ovary during pregnancy, it is desirable to limit the scope of surgical intervention by applying a Z-shaped suture to the bleeding area of ​​the ovary without removing the corpus luteum to preserve the pregnancy (if possible). It is advisable to use surgical laparoscopy, with the help of which blood is evacuated from the abdominal cavity and coagulation of the bleeding area of ​​the ovary is performed.

Traumatic injury of the vagina is a common and dangerous pathology in women more often of reproductive age. Causes of damage can be as follows:

1. Labor activity is one of the frequent causes of damage to the integrity of the reproductive organs. In this case, lesions from small abrasions and cracks to massive ruptures of the vagina and perineum are observed.
2. Conducting a medical abortion can cause a violation of the female genital mucosa, but is unlikely.
3. Injury to the vaginal mucosa can occur during defloration. Because when a rupture of the fleshy hymen occurs, the walls of the vagina can also be involved in the process, which threatens blood loss due to the presence of a large number of blood vessels.
4. Injury to the vagina occurs during normal sexual intercourse. In this case, most likely, the partners chose an unsuccessful position, or were in a state of intoxication, which dulled the woman's pain. This leads to stretching, in some cases, to rupture of the vaginal wall or displacement of the uterus to the side, which makes it very difficult for a future pregnancy to occur.
5. Rape is the most common cause of rupture of the walls of the vagina, posterior and anterior fornix, up to damage to the rectum and bladder. Often this happens with juvenile victims.
6. Mucosal damage can occur in older women, as the walls of the vagina lose their elasticity. Especially after the onset of menopause. Old scars and scars on the mucosa can also cause injury during sexual intercourse.
7. Mechanical damage to the vagina occurs during rape or the voluntary use of foreign objects in sex. This is especially dangerous when using piercing and cutting objects. It also includes criminal abortions. Such injuries are very dangerous, as they entail ruptures of the walls and arches of the vagina, penetrating wounds into the abdominal cavity with prolapse of the intestines into the vagina, rupture of the urethra and bladder.
8. Little girls can hide various small objects in the genitals during the game. This can lead to injury and inflammation.
9. Injuries to the vagina can be due to injuries from falls, such as pelvic fractures. As a rule, these are hematomas of different sizes.
10. Injuries to the vestibule of the vagina during sex occur with insufficient lubrication and rude, inept behavior of a man, which can lead to inflammatory processes and swelling of the mucosa.
11. A woman can injure the vaginal mucosa with frequent douching, and this leads to the washing out of the normal flora and, accordingly, to the development of chronic infections, since there is no local immunity.

Injuries to the female genital organs, especially minor ones, very often do not give bright symptoms immediately. Complaints of pulling pains in the lower abdomen, tension, pain when walking and sitting, bloody discharge, swelling of the mucosa appear after a while. Feeling discomfort, a woman understands that a vaginal injury has occurred, of course, if there were no health problems before certain events. How serious it is and what the consequences may be, the specialist will determine.

But with any discomfort, you need to contact a medical institution for advice in order to avoid disastrous consequences.

Because even the slightest scratch, and it can be infected, will lead to a serious inflammatory process.

With the above symptoms, there is time to think, since there is no direct threat to life. However, in cases of severe damage to the vaginal mucosa with ruptures and penetrating wounds to nearby organs, you should immediately contact an ambulance or get to the hospital on your own. Very often, a girl in such a state can no longer help herself, so this should be done by a nearby person. It is important to know that every minute counts, as we are already talking about saving lives.

What are the symptoms that you need to see a doctor urgently:

• Pain in the lower abdomen and in the vagina during intercourse or after it. The pain grows and has an intense character.
• Bleeding after intercourse. A pulsating stream of scarlet blood is considered especially dangerous, which indicates damage to a large artery.
• Fever.
• Discharge from the genitals of the contents of the intestine or bladder.
• Confused mind, stupor.
• Inability to urinate or severe pain with it.
• Bloody discharge and high fever after a medical (criminal) abortion or childbirth.

Treatment

First of all, if the condition of the woman allows it, the doctor talks with her about the presence of complaints of a certain nature in her lately and after the injury. Next, an examination of the external genital organs is carried out with the help of fingers and mirrors. The doctor takes swabs from the vagina for clinical analysis and for infection. If necessary, ultrasound and x-rays of the pelvic organs are done. In severe injuries penetrating into nearby organs, cystoscopy can also be performed, if the patient's condition allows.

Any damage to the vaginal mucosa is an indication for hospitalization in a hospital. Superficial abrasions are treated with antiseptic solutions and observed for several days to exclude the spread of infection to healthy tissues.

Serious injuries are treated with surgery. Tears, even minor ones, are indicated to be sutured, otherwise they become infected and form a source of chronic diseases. Also, damage that has not been repaired can later form scars and ulcers in the vagina, which will greatly complicate the life of a woman and jeopardize planned motherhood. Bleeding is stopped by tamponade or suturing of large damaged vessels and vaginal walls.

Hematomas of the genital organs are treated conservatively, prescribing resolving therapy and cold on the affected area. Only in the case of a large volume, the hematoma is opened, blood clots are removed and drainage is established. The stitching is shown next.

In case of rupture of the vaginal vaults, damage to the intestines or bladder, an abdominal operation is performed. Be sure to carry out a transfusion of blood or its components, because with such lesions, blood loss can be significant. The severity of hypovolemia is indicated by which woman will be given every 3 hours until stabilization. Further, in order to prevent the spread of infection, a course of antibiotic therapy is mandatory. General strengthening drugs are also prescribed. The rehabilitation course will be long, especially if the woman has been abused. In such cases, a psychologist should work. After surgical interventions, especially complex ones, one should refrain from sexual activity for up to 4-6 months.

If the genitals of a woman somehow do not correspond to the norm due to an injury, the specialist will definitely recommend plastic surgery. Especially if it's a young girl.

Consequences

The consequences can be very varied. Heaviness in the lower abdomen, sometimes mild pain, a tendency to inflammatory, infectious diseases. It all depends on the severity, area and nature of the lesion of the female genital organs. The time during which a woman was with this problem without qualified medical care is very important. Of course, in cases of complex surgery, especially when removing the reproductive organs, the woman will have a hard time. Firstly, this is a big hormonal failure with all its charms, and secondly, the psychological aspect. In this case, the support of loved ones is very important.

With simple damage and quick, effective intervention by a doctor, the prognosis is very favorable. If a girl has ignored a visit to a specialist for a long time, the infectious process can spread and cause great harm to her body. For example, prolonged inflammation of the vagina, even due to a shallow scratch on the mucosa, can lead to chronic inflammation of the fallopian tubes, and such a pathology is not compatible with pregnancy. But in this case, the consequences will not be associated with an injury, but with a negligent attitude towards one's own health.

Damage to the genital organs can be divided by location (external genital organs, vagina and uterus, urogenital and enterogenital fistulas), as well as by causes (birth, with bruises and bumps, falls, and also during sexual intercourse).

Damage to the vulva, perineum and vagina there are bruises, falls and during rough sexual intercourse. More often, hematomas and open wounds are formed. In case of damage to the vessels, massive bleeding can occur, especially when they are localized in the clitoris. Stab, cut and gunshot wounds of the female genital organs are observed infrequently, but they can be superficial and deep, penetrating into the retroperitoneal space and combined with damage to adjacent organs.

During sexual intercourse, especially the first, there may be injuries of the labia, perineum, vaginal walls(especially often in the posterior fornix), possibly with damage to the rectum, bladder, and even with penetration into the abdominal cavity. In the latter situation, the intestines can be damaged, develop peritonitis and sepsis. The clinical picture may be characterized by various symptoms. Bleeding, pain, sometimes incontinence of urine, feces, development of infection are more often observed.

The resulting hematomas can progressively increase, capturing adjacent tissues and organs. They can spread to the paravaginal tissue, perirenal area and other places.

Treatment in each case will be determined by the nature of the damage and its symptoms. Wounds are sutured with separate sutures, progressive hematomas are opened to find and ligate bleeding vessels. Quite often the tamponade of the bleeding sites is carried out. In case of damage to adjacent organs, they are restored, in some cases, operations are performed jointly by an obstetrician-gynecologist and a surgeon. If damage to the abdominal organs is suspected, an urgent laparotomy is performed, followed by suturing or resection of the intestine, suturing the bladder, etc.

Damage to the uterus occurs most often during abortion or childbirth. Cervical ruptures are observed during childbirth, as well as during the expansion of the cervical canal with Hegar dilators.

Damage to the body of the uterus (more often perforation) can be produced by a probe, dilators, curette, abortion collet and other items, especially when performing a criminal abortion. During an artificial abortion, perforation of the uterus is performed when the position of the uterus is not known before the start of the operation, if the cervical canal is not straightened during the operation, with its forced execution, as well as in cases of inferiority of the uterine walls during their curettage (in the postpartum period, during inflammatory processes, etc.). d.).

Clinical symptoms of uterine perforation can be pain and bleeding. Hematoma formation is possible. If the instrument penetrates the wall of the uterus into the abdominal cavity, then the intestines, bladder and other organs can be damaged by it. In this case, there are sharp pains and even shock. Treatment consists of laparotomy, suturing the opening on the uterus. In some situations, amputation of the uterus is performed. In case of damage to the abdominal organs, an appropriate surgical intervention is performed (on the intestines, bladder, etc.). When the uterus is perforated with a probe, conservative treatment is possible (bed rest, careful observation, antibiotic therapy). With ruptures of the cervix, it is sutured or plastic surgery is performed.

Urogenital and enterogenital fistulas can occur during pathological childbirth, gynecological operations, radiation therapy of malignant neoplasms. Genitourinary fistulas can be caused by damage to the lower (urethra), middle (bottom of the bladder) and upper (ureter) sections of the urinary tract. Gastrointestinal fistulas occur with ruptures of the perineum of the 3rd degree or with injuries of the rectum when using obstetric forceps, amniotomy. The clinical picture is characterized by urinary incontinence with genitourinary fistulas, gases and feces - with intestinal-genital.

Treatment - surgical (suturing fistulous openings by special techniques). In modern obstetric and gynecological practice, urogenital and enterogenital fistulas are extremely rare.

The causes of damage to the female genital organs can be bruises, falls, violent
actions, etc. In addition, damage to the genital organs often occurs during pathological childbirth or
operational aids in childbirth.

Conventionally, damage to the female genital organs can be divided into:

• damage to the external genitalia and vagina;
• uterine damage.

Damage to the external genitalia.

Most often occurs in girls when falling on blunt and sharp objects, less common
violent or traffic injuries.

The cause of injuries of the external genital organs can be pathological and operational
childbirth. Ruptures of the vagina, cervix, perineum, vulva most often occur in women in labor with
narrow pelvis, large fetus, abnormal presentation of the fetus, etc. Tears of the external genital organs
often accompanied by operative childbirth - the imposition of obstetric forceps, extraction of the fetus by
pelvic end. Prevention of birth traumatism will be an individual approach to delivery,
qualified midwifery.

With bruises and falls, hematomas, tissue ruptures, complicated
bleeding. When falling on sharp objects, penetrating wounds occur with damage to the vaults
vagina, urethra.

When raped, extensive ruptures of the walls of the vagina can occur with abundant
bleeding.

In transport accidents, there are combined injuries with damage to the pelvic bones,
pelvic organs, etc.

With damage to the external genital organs, the leading symptoms are pain and
bleeding. Pain can range from minor to traumatic shock. Blood discharge from
moderate discharge to heavy bleeding, accompanied by hemorrhagic shock. Diagnostics
damage to the external genital organs is based on the data of anamnesis and objective examination.

Examination of the patient must be carried out with full anesthesia, which will allow
determine the exact location of damage. After establishing the nature and extent of damage,
start therapeutic measures that include anti-shock measures,
surgical restoration of damaged tissues, replenishment of blood loss. First aid
consists in applying a pressure bandage to the bleeding area, applying cold. According to indications
intravenous administration of anti-shock and blood-substituting fluids is performed.

Uterine damage. Perforation of the uterus is the most common
during an abortion. The most dangerous perforation of the uterus with dilators or a curette, as this often occurs
damage to internal organs. If a complete perforation of the uterus is suspected, it is best to perform
diagnostic laparoscopy for a thorough revision of the state of internal organs. After confirmation
diagnosis of perforation, it is necessary to suture the wound of the uterus.

After the operation, women with a scar on the uterus should be
dispensary registration in the antenatal clinic. Pregnancy is excluded within the next year, such
time is needed for scar formation. Contraception is selected individually, taking into account age and
contraindications. The patient needs to undergo rehabilitation therapy, including
anti-inflammatory drugs, physiotherapy treatment aimed at prevention
formation of adhesions in the small pelvis. In patients planning pregnancy,
examination to clarify the condition of the scar on the uterus. In subsequent pregnancies, careful
observation, planned hospitalization at critical times and 2 weeks before the expected birth,
individual approach to the method of delivery.

Genital injuries are not very common. However, they can bring a lot of physical and psychological suffering. Such injuries can affect both men and women of all ages.

The causes of trauma to the genital organs can be very different. Most often, this is an accidental impact of a mechanical or thermal nature, but such cases can sometimes amaze the imagination with their unpredictability, which is associated with a purely human factor - a craving for a variety of, sometimes dangerous, experiments.

Features of injuries of the genital organs

In the general case, a trauma to the genital organs is a damage to the male or female genital organ of a different nature, violating its sexual and urinary functions. Such pathologies have different causes, localization and degree of damage. According to their localization, injuries are divided into open and closed.

Open type injuries include injuries that appear on the surface of external organs and are visible visually. The most characteristic manifestations are cut and bite marks, gunshot wounds, as well as traces of exposure to extreme temperatures. Injuries of a closed nature include internal injuries that are not visually noticeable: bruises, infringements, dislocations, etc.

The causes of injuries can be mechanical impact during impacts, falls, pinching; violent acts, thermal exposure or frostbite, abnormal sexual intercourse; aggressive impact with piercing, cutting objects or firearms; in women - childbirth, abortion, medical procedures. Despite the variety of causes, genital injuries have a number of characteristic symptoms: pain, swelling, hematoma, possible bleeding, gross hematuria, urethrorrhagia, impaired urination.

Male genital injury

Injuries to the male genital organ can occur on the penis or scrotum with damage to the skin tissue, corpus cavernosum or frenulum.

Closed damage

Injuries of the closed type include bruises, dislocations, fractures, infringements. The most common lesions are in the area of ​​the foreskin (head, cavernous body). Injury to the penis may be accompanied by damage to the scrotum and adjacent organs.

Bruising of the penis is a fairly common occurrence and can occur when playing sports (bicycle, gymnastic bars, etc.), hitting, falling. With such an injury, bleeding of varying degrees occurs into the skin of the penis or into the subcutaneous layer. There may be extensive bleeding caused by a violation of the cavernous bodies. The process is accompanied by swelling and blue (sometimes blackening) of the skin of the penis. The hematoma may spread to the scrotum and groin. The treatment of such damage consists in providing a state of rest for the organ, as a result of which the hematoma gradually resolves on its own.

Dislocation of the penis is a situation in which there is a rupture of the ligaments connecting the penis to the pubis, which causes a displacement of the cavernous body into the scrotum, under the femoral skin or above the pubic arch. Damage is accompanied by swelling, hemorrhage, hematoma, problems with urination. Treatment in this case is carried out by an operative method: reduction of the penis, ligation or suturing of the torn ligament.

A fracture of the penis can only occur with an abnormal load on a penis that is in an erect state. With this injury, the protein shell of one or all three cavernous bodies is torn. The main symptoms are a strong pain sensation, an increase in the volume of the penis due to hemorrhage and edema, dark blue skin color; in this case, the hematoma passes to the pubis, perineum, scrotum and femoral zones. Treatment - immobilization of the penis with a bandage, the introduction of calcium chloride intravenously, the application of a cold compress; with extensive bleeding - surgery to stitch the gap.

infringement

An injury in the form of an infringement of the penis appears as a result of tightening a tight bandage on it, putting on an object, which is typical for little-conscious actions in childhood. Circular infringement of the organ leads to a violation of the venous outflow and the appearance of a noticeable edema. With prolonged and strong tightening, atrophy of the peripheral part of the penis or urethra may begin. The task of treatment is to quickly remove the infringing object.

All of these types of traumatic effects can damage the scrotum and testicles. If they are significantly damaged, the general condition of a person worsens, a strong pain shock can occur with very dangerous consequences.

Open damage

Open injuries include wounds of varying depth and degree of damage. Incised wounds have an extended character with fairly smooth edges. The degree of bleeding depends on the depth of the wound. It can be plentiful, which stops by chipping the vessels. To restore the integrity of the tissue, catgut sutures are used, a more complex intervention is required for partial amputation of the organ. A stab wound is also characterized by bleeding of varying intensity, which, with minor injuries, stops after initial treatment. Significant punctures are sutured. Scalping wounds are characterized by tearing of the skin from the mucous membrane of the preputial sac. The resulting skin defect requires plastic surgery.

When exposed to low temperatures, frostbite of the penis, most often the foreskin, is possible. Symptoms - pain, itching, induration at the end of the penis. Within 3 days, redness, swelling develops, pain intensifies, the skin in the lower zone darkens and ulcerates. Treatment is carried out by removing dead particles and using potassium permanganate.

The burn of the penis is manifested by severe penetrating pain, swelling, erythema. 2nd and 3rd degree burns cause blistering, necrosis, and eschar. Treatment includes the appointment of painkillers, antibiotics and sulfonamides; an antiseptic dressing is applied.

Injuries of the female genital organs

Damage to the female organs are divided according to their causes: ruptures during sexual intercourse, damage as a result of a dangerous object entering the vagina, impact; cut, stab or gunshot wounds; unsuccessful medical impact, frostbite and burns.

Sexual injury

There are known cases of rupture of the vaults and the fleshy septum of the vagina, damage to the cavernous bodies of the clitoris during intercourse with an uncomfortable position of the body, excessive intensity, violent actions, etc. Sometimes there are significant gaps in the external elements and neighboring organs. In this case, damage is found in the rectum, vaginal vaults all the way up to the abdominal cavity.

Left untreated, vaginal tears can cause anemia, peritonitis, and sepsis.

The main sign of damage is profuse bleeding. Treatment - suturing after injection with novocaine and adrenaline.

Mechanical damage

Injuries to the vulva and vagina often occur as a result of blows, falls on various objects, bruises. As a result of mechanical influences, the walls of blood vessels are stretched and ruptured with the formation of extensive hematomas, which can spread to the external organs, perineum, tissue around the vagina, and even cause anemia. The following symptoms appear: swelling, pain, deformity of the vulva, and if an infection enters, the temperature rises, chills occur. Treatment - bed rest, ice compress, taking vitamins K, P and C, as well as calcium chloride. With severe bleeding - surgical treatment.

Increased risk of ruptures of tissues and vessels of the clitoris due to heavy parenchymal bleeding. If the injury is caused by a sharp object, damage to the penis is accompanied by destruction in the bladder, rectum.

Foreign object damage

Often, damage to the female genital organ is due to the ingress of sharp objects into the vagina, incl. with poor quality medical treatment. In this case, trauma to the uterus or its cervix may occur. The hit of the object is determined by radiographic method or palpation of the cervix. Quite often, such injuries are caused by artisanal abortions.

Urethral injury

Injury to the urethra quite often becomes a side effect of damage to the penis during mechanical action. This effect leads to a violation of the integrity of the walls of the urethra, which greatly complicates the overall clinical picture. Such injuries are accompanied by serious consequences, such as pain shock, inability to urinate, the appearance of urine infiltration and urohematoma, fistulas. The main symptoms are signs of urethrorrhagia, urinary retention, a hematoma with a transition to the perineum and pelvic region. Treatment is based on artificial diversion of urine, opening of a hematoma and urinary infiltrates, restoration of integrity and patency of the urethra.

What is the most vulnerable spot on the body of every man? If you ask this question to a representative of the stronger sex, then you will receive only one answer - the intimate zone. Men are very afraid of getting hit on the reproductive organs, because it not only hurts, but can also affect the reproductive function in the future. Even a small wound on the penis or testicles gives a lot of discomfort. In addition, doctors warn that damage to the skin of intimate organs increases the risk of infection and bacteria entering the wounds.

Classification of injuries of the genital organs in men

Absolutely all injuries of the genital organs in men are classified into several main types:

• Tearing of the frenulum of the penis;
• Mechanical damage to the penis;
• Biting wounds of the penis;
• Stab and cut wounds;
• dislocation of the penis;
• Pathological testicular torsion;
• Infringement of the penis or testicles.

Mechanical, chemical, thermal lesions of the penis lead not only to damage to the foreskin and glans in a man, but also to a complete or partial loss of reproductive function.

Causes of damage to the penis

The most common cause of damage to the penis in a man is inaccurate sexual intercourse with a physiologically short frenulum. Such injuries are immediately accompanied by severe pain, bleeding, violation. In this case, the man should immediately go to the hospital for surgery (there are no other ways to eliminate such mechanical damage).

If the skin of the penis is damaged by moving mechanisms, then in this case the man experiences intense pain, profuse bleeding from large deep wounds. Quite a few cases are known that resulted in a partial or complete detachment of the skin from the penis and scrotum.

In the above case, trying to independently remove the damaged organ from the gripping mechanism is not worth it. The victim must immediately call an ambulance. The torn-off skin area must be delivered to the hospital without fail. If this is not done, then the damage to the skin will need to be covered with skin from the thigh or from the abdominal wall.

What to do with cut wounds of the penis?

Injuries to the penis can be stabbed, cut, bitten, quite plentiful and extensive. If the wound is exclusively superficial, then in this case the bleeding will not be so plentiful and extensive. But, if as a result of damage the so-called cavernous body is damaged, then the patient may experience a sharp pain shock and profuse blood loss.

Penile bruises

Bruising of the penis is the injury of the male genital organs, which occurs most often in everyday life. With a bruised penis, a man may experience symptoms such as:

• Unpleasant painful crunch of the penis;
• Unbearable intense pain at the site of injury;
• Hematoma;
• Enlargement of the penis in size;
• Change in the natural color of the penis to blue with purple hematomas and smudges.

How to provide first aid?

In case of damage to the penis, it is very important to provide first aid in time to avoid serious consequences. In case of severe damage to the intimate organ, apply a bactericidal bandage with any disinfectant solution - alcohol, iodine, brilliant green.

If the penis was completely injured with cutting off some of the parts of the organ, then everything possible must be done to save it.

Important! When cutting off the penis (or one of its parts), it is necessary to get to the surgical department within a few hours in order to have time to perform an operation to save the organ.

First aid in the treatment of any injury to the penis should be to provide rest to the victim, the application of cold and referral to a medical facility.

Remember that a penile fracture can occur even during active intercourse. It is simply impossible not to notice a penis fracture, as obvious severe pain and a loud click will make themselves felt. For some time after the fracture, the penis acquires a black tint and increases in size due to profuse hematomas. As a rule, along with a fracture of the penis, the patient has mechanical damage to the urethra (urethra), as a result of which it is very difficult and extremely painful for the patient to go to the toilet.

With dislocations of the penis, one of its parts may shift into the perineum or pubic region. Refusal to go to a surgeon after damage to the penis leads to a complete loss of reproductive function and organ.

Damage diagnostics

It is forbidden to independently determine the nature of damage to the penis. To do this, you need to contact the doctors with the appropriate complaints. Diagnosing penile injuries is not a difficult process.

During the examination, the doctor must first determine the degree of damage to the penis and the urethra in particular. An x-ray and MRI may be needed to confirm the diagnosis.

Prevention of penile injury

As such, there is no special prophylaxis of the penis. If we talk about everyday situations, then men are recommended to choose a type of trousers where the penis will not be transferred, and the lightning is at a certain distance from the scrotum.

During intercourse, try to avoid aggressive positions that can lead to damage.

Treatment of penile injuries

The main reason that men are in no hurry to seek medical help is increased embarrassment. But, what embarrassment can we talk about when it comes to the fact that the patient runs the risk of being left without a functioning sexual organ. Remember that without proper medical care, the risk of getting it is about 80%.