Most genital trauma occurs in men and includes injury to the testes, scrotum, and penis. Genital mutilation of women by removing the clitoris, which is done in some cultures, is a form of genital trauma and child abuse (see Child Maltreatment: Female Genital Mutilation).
Most testicular injuries result from blunt trauma; penetrating testicular injuries are less common. Testicular injuries are classified as contusions or, if the tunica albuginea is disrupted, as ruptures.
Scrotal injury may be caused by penetrating trauma, burns, and avulsions.
Penile injuries have diverse mechanisms. Zipper injuries are common. Penile fractures, which are ruptures of the corpus cavernosum, occur most often when the penis is forcibly bent during sexual activity; urethral injury may also be present. Amputations (usually self-inflicted or from clothing trapped by heavy machinery) and strangulations (usually from constricting penile rings used to enhance erections) are additional mechanisms. Penetrating injuries, including animal bites and gunshot wounds, are less common and may also involve the urethra.
Complications of genital injuries include erectile dysfunction, hypogonadism, infection, tissue loss, and urethral scarring.
Symptoms and Signs
Symptoms after a direct scrotal blow are usually scrotal pain and swelling. Signs may include scrotal discoloration and a tender, firm scrotal mass that fails to transilluminate, suggesting a hematocele. Scrotal penetration suggests the possibility of testicular involvement. Often the examination is limited by patient discomfort. Penile fracture typically results in a cracking sound, immediate pain, marked swelling and ecchymosis, and usually visible deformity.
Diagnosis of external scrotal and penile injury is made clinically. Clinical diagnosis of testicular contusion and rupture can be difficult because the degree of injury may be out of proportion to the physical findings, so patients with blunt testicular injury typically require scrotal ultrasonography. Most penile injuries are evident on physical examination. An x-ray with urethral contrast (retrograde urethrogram) should be done for any patient with penile fracture or penetrating penile injury because of the high incidence of coexisting urethral injury.
Patients with penetrating testicular injuries or clinical or sonographic characteristics that suggest testicular rupture require surgical exploration and repair. Similarly, all penile fractures and penetrating injuries should be surgically explored and the defects repaired. Penile amputations should be repaired by microsurgical reimplantation if the amputated segment is viable. Strangulation injuries can usually be managed simply by removing the constricting agent. Zippers should be removed (see Fig. 1: Genitourinary Tract Trauma: Zipper removal from penile skin.).
To remove a zipper, local anesthetic is injected into the area. Mineral oil is used to lubricate the zipper, and then one attempt is made to unzip the zipper. If this attempt is unsuccessful, a sturdy wire cutter (diagonal cutter) is used to cut the median bar on the top of the zipper slider, which connects its front and back plates. Then the slider falls off in 2 pieces, and the zipper teeth come apart readily.
Last full review/revision February 2007 by Noel A. Armenakas, MD