Vulvar injury

Introduction Vulvar injury refers to genital rupture or hematoma caused by accidental injury or sexual intercourse injury called vulvar injury. The objects touch the vulva, such as tip piles, bicycle girders, sticks, etc. The injury is generally limited to the vulva, but it can also hurt the inside of the vagina. Most of the injuries are hematoma formation, contusion, and penetrating injury.

Cause

Causes of genital damage: Although the vulva position is more concealed, damage is not uncommon. Here the tissue is thin, nerve sensitive, rich in blood vessels, and the damage is heavy and painful after injury. Common injuries are hematoma, contusion, bleeding, etc. The vulva is anus behind, and the bacteria in the intestine are easy to cause secondary infection in the injury, which complicates the condition, such as contraction of the scar to form vaginal stenosis, stenosis of the urinary tract, adhesion of the labia minora, and difficulty in childbirth. The main cause of injury is riding a fall and sexual intercourse.

an examination

Related inspection

Vulvar gynecological routine examination gynecological examination

Diagnosis of vulvar injury examination: physical examination can be diagnosed.

Differential diagnosis of vulvar injury:

1, vulvar hematoma

Common causes of vulvar hematoma are falls, bruises, and can also be seen in sexual intercourse injuries. The subcutaneous and submucosal tissues of the vulva are loose and the blood vessels are rich. Once the blood vessels rupture, the hematoma is easily formed, and the local tissue often has obvious swelling, falling feeling and severe pain. The hematoma can spread up through the paravaginal tissue to the broad ligament and even the fat sac around the kidney. Severe bleeding may be associated with hemorrhagic shock. Check the vulva surface skin swelling is dark purple, shiny, severe hematoma spread to the pubis. The hematoma has a large tension and obvious tenderness. If there is a laceration on the surface, there is bleeding. Patients with vulvar hematoma must be examined in detail to find out whether there is a laceration in the urethra, vagina, etc. Vulvar hematoma is easy to be complicated by infection and should be noted.

Differential diagnosis

Differential diagnosis of vulvar injury:

1, vulvar hematoma

Common causes of vulvar hematoma are falls, bruises, and can also be seen in sexual intercourse injuries. The subcutaneous and submucosal tissues of the vulva are loose and the blood vessels are rich. Once the blood vessels rupture, the hematoma is easily formed, and the local tissue often has obvious swelling, falling feeling and severe pain. The hematoma can spread up through the paravaginal tissue to the broad ligament and even the fat sac around the kidney. Severe bleeding may be associated with hemorrhagic shock. Check the vulva surface skin swelling is dark purple, shiny, severe hematoma spread to the pubis. The hematoma has a large tension and obvious tenderness. If there is a laceration on the surface, there is bleeding. Patients with vulvar hematoma must be examined in detail to find out whether there is a laceration in the urethra, vagina, etc. Vulvar hematoma is easy to be complicated by infection and should be noted.

2, hymen laceration

Due to the one-time delivery, the degree of laceration can be different. Generally, the injury is not heavy, only a small amount of bleeding and pain, and more self-healing. Check the hymen for a small gap, the edge of the gap is dark red with a small amount of blood. However, if the action is rude, the posture is wrong, or the postpartum, elderly women, or vaginal shortening after surgery can often cause severe laceration, even involving the lower part of the vaginal discharge, sputum or vestibular, can cause severe bleeding. Through the vulva and vaginal examination, the degree of laceration can be ascertained. In addition, accidental injury can also cause hymen laceration.

3, vulvar childbirth injury

Common causes of genital birth injury are excessive perineal, excessive productivity, fetal oversize, malposition and misoperation. Clinical manifestations of local bleeding and pain. Examination can be found in the vestibule, around the urethra, the inside of the labia minora, the perineum and the vagina have a split wound, sometimes multiple soft tissues can appear hematoma. The perineal laceration can be divided into three degrees: 1 degree 1 laceration: refers to the perineal skin, mucous membrane, labial ligament, vestibular mucosa, vaginal mucosa, etc. There is tear, but the muscle layer is not involved, generally no bleeding; 2 2 degree laceration: refers to tears involving the pelvic floor muscles and fascia, such as the bulbospongiosus muscle, perineal superficial transverse muscle and levator ani muscle, but the anal sphincter remains intact; 3 second degree laceration: refers to the anal sphincter Or partial tear, even the anterior wall of the rectum can be torn, in the latter two cases, local bleeding is more, if not sutured in time, it can also cause shock due to persistent bleeding.

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