Most genital injuries occur in men and may involve injury to the testes, scrotum, and penis. Genital injuries occur most commonly on the battlefield because of the ground explosives used there. Genital mutilation by removing the clitoris in females, which is done in some cultures, is a form of genital trauma and child abuse.
Several types of injuries can affect the penis. The penis can be partially or fully severed. Reattachment of a severed penis is sometimes possible, but the extent of recovery of sensation and function varies. Constricting penile rings, applied to enhance erections, can possibly strangle the penis and cause permanent damage. Removing the ring is usually all that is necessary. Penetrating injuries, including animal and human bites and gunshot wounds, are less common and may also involve the urethra. Surgery may be required to treat injuries of the penis and injuries of the urethra.
(See also Overview of Urinary Tract and Genital Injury.)
Excessive bending can fracture an erect penis. Such bending may occur during vigorous sexual intercourse if the penis is stubbed against the partner’s pelvic bone. Fracture of the penis may also involve a urethral injury. The “fracture” is actually a tear in the covering (tunica albuginea) of one of the two tube-like structures in the penis (corpus cavernosum) that hold the additional blood flow that maintains erection.
The man has immediate pain, swelling, and discoloration, and the penis appears deformed. Prompt surgery is usually necessary to repair such fractures to prevent abnormal curvature of the penis or permanent erectile dysfunction.
The location of the scrotum makes it susceptible to injury. Blunt forces (for example, a kick or crushing blow) cause most injuries. However, occasionally gunshot or stab wounds penetrate the scrotum and testes. Rarely, the scrotum can develop severe and rapidly progressive infections such as gangrene. If gangrene develops, the involved tissues are surgically removed and the man is given broad-spectrum antibiotics by vein (intravenously). Reconstructive surgery can be done after the infection is controlled.
Testicular injury causes sudden, severe pain, often with nausea and vomiting. Ice packs, a jockstrap, and drugs for pain and nausea usually effectively treat a bruised testis (bleeding in and around the testis). Ultrasound examination is done to confirm whether the testis has ruptured. A ruptured testis requires surgical repair. Injury to the testis can destroy the capacity for sperm or sex hormone (mainly testosterone) production. If both testes are injured, testosterone replacement may be necessary. If only one testis is injured, the remaining testis usually produces as much testosterone as the body needs.