Non-obstetric vulval trauma

Abstract

Objective: To describe the mechanism, injury pattern and management of women who present to the ED with non-obstetric vulval trauma.

Methods: A retrospective, single-institution case series was carried out. Data were sourced from medical records of women who presented to the ED and Royal Brisbane and Women's Hospital between 2007 and 2011. Records of possible injuries to the vulva were assessed to determine incidence, age, site, type of injury, mechanism of injury and whether urinary retention required treatment. This information was analysed using the computer software Statistical Package for the Social Sciences 11.0.

Results: Vulval non-obstetric trauma was found in 19 of 519 cases, resulting in haematoma formation, lacerations, tears or a combination of the three in 16 of the 19 cases. Injuries were due to falling astride a firm object, consensual coitus, sexual assault, cold waxing and tight clothing. Urinary retention occurred in three cases. Site of injury, whether anterior or posterior, was evenly distributed irrespective of the mechanism of injury. Haematomas were treated conservatively and bleeding lacerations sutured. None required resuscitation.

Conclusions: Non-obstetric vulval injuries are uncommon (incidence 3.7%). All cases require assessment for vaginal, urethral, anal and bony pelvis injuries. This might require examination under anaesthesia. Conservative management of haematomas in the absence of acute haematoma expansion is favoured. The need to screen for sexually transmissible infections and pregnancy is important. Social worker and psychological support is important to reduce the incidence of long-term psychological problems.