Injuries to the female genital organs during sex: causes, symptoms, treatment. Prevention of injuries to the female genital organs. Isolated injuries of the female genital organs Classification of injuries to the female genital organs received during sex

Injuries to the genital organs develop as a result of falls, especially on sharp and piercing objects, during sexual intercourse, when hard and sharp objects and instruments are inserted into the vagina and uterine cavity (bougies, metal catheters, dilators, etc.).

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

Injuries resulting from a fall on sharp, piercing objects during sexual intercourse usually represent lacerations with extensive damage to the walls, and often the vault of the vagina, with the formation of hematomas spreading to the pelvic tissue. Perforation of the vaginal vault with sharp instruments is also accompanied by the formation of stab and laceration wounds. In this case, damage to the pelvic organs - bladder, intestines - is possible. Damage to the upper third of the vagina is also usually accompanied by significant bleeding.

The clinical picture of pelvic injuries is varied: depending on the severity of the injury, the condition of patients can be from satisfactory to collapsed. From the genital tract, bleeding ranges from slight to severe. In case of injury to the external genitalia, examination reveals crush injuries, ruptures, and hematomas. The diagnosis is clarified when collecting anamnesis (indications for the introduction of instruments for fetal expulsion, etc.).

At the prehospital stage, in case of heavy bleeding from wound sites on the external genitalia, the application of a pressure T-shaped bandage is indicated. In case of massive blood loss or shock, the administration of blood replacement solutions, vitamins (ascorbic acid), and cardiac medications should be urgently started. The same treatment continues while the patient is being transported.

In all cases of genital trauma, urgent hospitalization to the gynecological department is required. Since without a special gynecological examination it is difficult to correctly assess the severity of the injury, the patient must be hospitalized on a stretcher and transferred directly to the hospital doctor.

Treatment of genital injuries is usually surgical. It consists of careful treatment of the wound, stopping bleeding by ligating blood vessels or using tamponade. The rupture is sutured less frequently (provided the wound is fresh, “uncontaminated”). For injuries penetrating the vaginal vault, laparotomy is indicated. At the same time, anti-shock measures are carried out, anti-tetanus serum is administered, and the inflammatory process is prevented and treated.

How are traumatic injuries to the female genital organs classified?

Foreign bodies.

Fresh wounds and damage to the genital organs:

Fresh injuries caused by sexual intercourse;

Fresh injuries not related to sexual intercourse;

Injuries caused by cutting and piercing objects and firearms;

Burns.

Old injuries to the genital organs and their scarring:

Damage (ruptures) of the perineum and vagina;

Damage to the uterus. Genitourinary and enterogenital fistulas.

What are the most common complaints when foreign bodies are ingested?

The most common complaints are pain, leucorrhoea (usually foul-smelling), and spotting.

Under what circumstances can foreign bodies enter the vagina?

Foreign bodies can enter the vagina in the following cases:

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

When using contraceptives - male and female condoms;

When introducing various objects into the vagina for the purpose of abortion, masturbation, etc.

How are foreign bodies in the vagina recognized?

Recognition of foreign bodies in the vagina is based on gynecological examination using speculum, as well as digital examination and is not difficult.

What are the basic principles of treatment?

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

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

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

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

What is the name for damage to the hymen during first sexual intercourse?

Damage to the hymen usually occurs during the first sexual intercourse - defloration (defloratio). In this case, tears in the edges of the hymen are shallow and are accompanied by minor bleeding.

What are the reasons for its pathological rupture?

Sometimes, during the first sexual intercourse, the hymen ruptures to its base and is accompanied by heavy 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 due to roughness and violence.

Damage to the vagina occurs due to underdevelopment, decreased elasticity, or excessive softening of the walls.

Where does vaginal rupture usually occur?

The vaginal walls usually rupture in the upper third in the area of ​​the posterior or one of the lateral vaults. When there is a deep tear in the side wall of the vagina, the pelvic tissue is exposed. It is extremely rare that a rupture of the vaginal vault is accompanied by a violation of the integrity of the peritoneum lining the rectouterine cavity (Douglas pouch). In such cases, prolapse of intestinal loops may occur.

What are the symptoms of genital rupture?

Symptoms of genital ruptures due to sexual intercourse are pain and bleeding, sometimes very profusely. The causes of bleeding are ruptured veins, cavernous lacunae, arterial branches.

What is the diagnosis of such ruptures based on?

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

What are the tactics of surgical treatment in infected and uninfected cases?

Treatment in non-infected cases is surgical: the bleeding vessels are tied up and sutures are placed on the edges of the ruptured tissue. If a bleeding vessel is not detected, then a submersible catgut suture is applied to the bleeding area. If a fresh rupture of the vaginal wall penetrates deeply, then the wound should be sutured layer-by-layer and sequentially. If the intestines are damaged, transection is indicated.

In infected cases, one should limit oneself only to ligation of bleeding vessels or suturing 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 classified as accidental injuries during medical procedures?

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

What most often occurs with blunt trauma to the external genitalia?

Blunt trauma occurs due to the impact of blunt objects (bruise) or indirectly (with 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 location of the injury, can form in the area of ​​the external genitalia, on the perineum, or in the vagina.

What are the symptoms of a vulvar hematoma?

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

What is the diagnosis of vulvar hematoma based on?

A hematoma is recognized by examining the external genitalia and digital examination of the vagina.

What are the basic principles of treatment for vulvar hematoma?

Treatment should primarily be aimed at stopping bleeding, preserving the integrity of the hematoma to avoid infection, and reducing pain. For this purpose, rest is prescribed,

painkillers, ice pack. If the hematoma grows along with symptoms of anemia, then it is opened with a wide medial incision, clots are removed, and bleeding vessels are sutured. The hematoma cavity is drained. Antibiotics are prescribed prophylactically. In case of significant blood loss, the volume of circulating blood volume 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 wounds?

Treatment consists of applying hemostatic sutures.

How is a diagnosis made for a vaginal injury?

The diagnosis is made after examining the vagina using speculum.

What are the tactics of surgical treatment of vaginal wounds?

Treatment consists of primary surgical treatment of the wound and suturing. If the integrity of the peritoneum, bladder and intestines is damaged, transection is indicated.

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

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

What are the treatment tactics for genital burns?

The 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 cicatricial deformation of the cervix?

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

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

What symptoms may occur with cervical deformation?

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

What are the “generally accepted” surgical methods for treating cervical scar deformity?

These methods include the Emmett operation, cone-shaped amputation according to Sturmdorff and wedge-shaped amputation according to Schroeder, high amputation of the cervix, plastic surgery of the cervix using the dissection method according to V.I. Eltsov-Strelkov.

What is the advantage of surgical treatment of cicatricial deformity of the cervix using the method of V.I. Eltsova-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 outer skin.

What fistulas are distinguished?

There are:

Vesical fistulas: vesicovaginal, vesicouterine, vesico-adnexal;

Ureteral fistulas: ureteral, ureteric-vaginal, ureteral-uterine;

Urethrovaginal and urethrovesical-vaginal fistulas;

Combined fistulas: genitourinary, ureterintestinal.

Complex genitourinary 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;

Trauma caused to the genitourinary organs and intestines during operations and manipulations;

Developmental anomalies;

Malignant formations in the stage of tumor disintegration;

Radiation damage;

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

Tuberculosis 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?

Urogenital fistulas are much more common than entero-genital fistulas due to the fact that the urethra and the isthmus of the bladder are located behind the pubic arch and 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 fistulas include the following:

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;

For fistulous openings between the cavity of the abscess (pyosalpinx, abscess of the rectouterine cavity, etc.) and the vagina; pus flows out of the latter.

What is the diagnosis of fistulas based on?

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

If urine leaks continuously, but spontaneous urination is also possible, a ureterovaginal or very small vesical-vaginal fistula should be considered.

A fistula with a large diameter is also detected by simple examination using speculum or two-manual vaginal examination. You can use probing of the fistulous tract through the vagina, a test with filling the bladder. To do this, about 200 ml of a sterile coloring disinfectant is introduced (rivanol 1:1000, methylene blue 1:2000, potassium permanganate 1:1000). When examining the vagina using mirrors, fluid leakage from the fistula 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 x-ray examination using water-soluble contrast agents (fistulography).

What treatment method is applicable for this pathology?

Treatment is only surgical (Fig. 14.4). The operation is performed no earlier than 4-6 months later. after the formation of a fistula. The principle of the operation of suturing a 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 an enterovaginal fistula: I - with dissection of the external pharynx: a - cut line (1 - external pharynx; 2 - fistula); b - the muscular layer is highlighted; c - first row of sutures (muscular-muscular); d - second row of sutures (on the mucous membrane); II - without dissection of the external pharynx: a - cut line (1), fistula (2); b - first row of sutures (muscular-muscular); c - the first row of stitches, covered with a flap of the back row

After this, interrupted, separate sutures are used to connect the edges of the wound so that the ligatures pass transversely through the muscle layer of the bladder. The second row of interrupted sutures is placed on the tissue of the bladder, and the third - on the vaginal wall. In the postoperative period, a permanent catheter is inserted, and the bladder is washed with antiseptic solutions and antibiotics.

Fecal fistulas are sutured through the vagina - the edges of the fistula opening are excised and layer-by-layer sutures are placed on the edges of the fistula tract without piercing the intestinal mucosa.

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

Prevention consists of 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 postpartum women in the postoperative and postpartum periods.

What are the characteristics of trauma to the female genital organs in girls?

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

What are the features of treatment tactics for girls?

Features of providing medical care to girls include effective pain relief, prevention of shock, and suturing ruptures with atraumatic needles.

Name:

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

Types of genital injuries

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

Symptoms of genital injuries

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

Treatment of genital injuries

Regardless of the cause of the damage, determining its volume requires a thorough examination in a hospital setting, which includes, along with the initial examination, special methods (rectoscopy, cystoscopy, radiography, ultrasonography and nuclear magnetic resonance imaging, etc.).

Treatment of genital injuries is usually surgical. It consists of careful treatment of the wound, stopping bleeding by ligating blood vessels or using tamponade. The rupture is sutured less frequently (if the condition of a fresh “uncontaminated” wound is met). For injuries penetrating the vaginal vault, laparotomy is indicated. At the same time, anti-shock measures are performed, anti-tetanus serum is administered, and the inflammatory process is prevented and treated.

To serious enough to require the help of a doctor.

What is considered an injury?

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

In large cities, several women a month visit doctors with injuries after intimate 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.

Small thing, but unpleasant

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

While healing these wounds, you should refrain from sexual intercourse and use antiseptic solutions (Epigen or Miramistin). This will prevent microtraumas from becoming infected. If the pain does not go away within 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 clitoris, labia), growing hair in intimate places or facial stubble (in the case of oral sex). Using sophisticated poses, you can get dislocations and sprains.

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

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

One of the typical traumatic injuries from sex on carpets is burns to the back and lower back, usually in women. They occur due to intense friction against the carpet pile with the skin. After some time, redness with a strong burning sensation forms on the skin, the integrity of the skin is damaged or a blister forms, like a burn.

More serious injuries

During very rough sex, injuries to the genital organs are possible, causing pain in the groin area, problems with urination and pain during urination. In addition, if the partner's penis is large, the woman may develop internal injuries - ruptures of the anterior wall of the vagina or vaginal vault (the area of ​​transition to the cervix).

With a sharp and deep insertion of the penis into the vagina, sharp pain and bleeding may occur, especially if the angle of insertion is not parallel to the axis of the vagina. This can occur when changing position and throwing a woman’s legs over a man’s shoulders. Similar injuries are experienced by women whose partners have impressive “dignity” sizes, as well as those who use sex toys that are not physiologically large.

With deep penetration, injuries to the uterus and ligaments are possible - with a strong push from 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 during unconventional sex

Injuries during sex in women

The leader in injuries is anal sex; during intimate relationships, the rectal mucosa can be damaged, and the rectal sphincter can be torn, with resulting physiological problems.

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

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

Exotic injuries

Sometimes, in particularly emotional and fearful women, sudden sounds or movements can trigger a stress mechanism - a strong reflex spasm of the vaginal muscles with pinching of the penis in it. This condition is called vaginismus, and it is funny only for those who have not been in such a situation.

In order to free herself from the “death grip”, a woman needs to tense the muscles in the abdominal area, simulating going to the toilet “in a big way”. To save his “dignity,” a man needs to insert his index finger into his partner’s anus and pull it back strongly. If these manipulations do not help, call an ambulance; only doctors can relieve the spasm.

In most cases, we have to deal with manifestations of mechanical trauma, associated mainly with falling on blunt and sharp objects, blows, sometimes with the introduction of foreign bodies into the vagina or urethra (parts of fountain pens, hairpins, pins, etc.), masturbation, attempts to have sexual intercourse intercourse or rape, as well as injuries to the genitals at work, during physical education and sports, as a result of road accidents, etc. Most often, the vulva, perineum, vaginal walls, penis, scrotum and its organs are damaged; in women of childbearing age, damage is mainly associated with gross defloration, abortion and childbirth.
Damage to the vulva with the formation of a hematoma often occurs after childbirth, less often due to a blow or fall on a blunt object. There is pain, tension, and difficulty walking. Treatment is mainly conservative (bed rest, cold, hemostatic agents, etc.), followed by resorption therapy. If the hematoma grows or suppurates, hospitalization is necessary. Damage to the clitoris usually occurs as a result of domestic trauma or childbirth and is accompanied by severe bleeding, sometimes life-threatening. Swelling and hematoma occur in the perineum and in the labia area; in some cases, when the wound becomes infected, the temperature rises, pallor, cold sweat appear, blood in the urine, pain when urinating, and involuntary passage of gas and feces may occur. A sterile pressure bandage and an ice pack are applied to the area of ​​the external genitalia. Treatment consists of suturing the mucous membrane over the clitoris. Tears of the hymen outside of sexual intercourse, as a rule, do not reach the base of the hymen, are located close to the perineum, posteriorly towards the scaphoid fossa, where natural notches almost never occur. Usually accompanied by minor pain and bleeding that stops quickly; healing occurs within 7-10 days, complications are not uncommon. Damage to the tissues of the perineum, vagina and cervix often occurs during childbirth. They can be observed in the form of superficial abrasions and cracks, often ruptures. The occurrence of perineal ruptures, which more often occur in primiparous women, is facilitated by insufficient elasticity (rigidity) of tissues in primiparous women over 30 years of age, scars after previous births, structural features (high perineum), as well as a large fetus, excessively dense fetal skull bones in post-term pregnancy , the use of obstetric forceps, etc. Vaginal ruptures occur when there is insufficient extensibility of its walls, a narrow vagina, a large fetal head, rapid or protracted labor; may be a continuation of the perineal rupture. Lacerations of the vagina and perineum predispose to the occurrence of prolapse and prolapse of the genital organs; unrepaired injuries or ruptures, the suturing of which was performed technically incorrectly, are especially dangerous. Cervical ruptures are most often observed during childbirth in the form of shallow tears at its edges and are not accompanied by bleeding. During pathological childbirth, cervical ruptures occur, accompanied by significant bleeding and other pathological consequences. Cervical erosion, endocervicitis, ruptures during previous abortions, childbirth, excessive density, inflexibility of the cervix, as well as surgical intervention during childbirth, etc. contribute to the occurrence of ruptures. Unsutured ruptures become infected, and a postpartum ulcer forms in the wound area, which is a source of further spread of infection. During the healing process of an unsutured rupture, scars are formed that contribute to cervical eversion. Cervical inversion predisposes to chronic inflammation of the mucous membrane and erosion of the cervix, sometimes leading to the occurrence of precancerous diseases and cervical cancer.
Cervical ruptures can occur not only during childbirth, but also during artificial termination of pregnancy, especially in nulliparous women. Trauma to the uterus can occur during induced abortion, childbirth and is a severe obstetric and gynecological pathology. The possibility of perforation of the uterus during an abortion is caused by the use of sharp surgical instruments during one radio, virtually “blindly”. The risk of this complication increases with pregnancy 11-12 weeks, as well as with criminal abortion. Delayed diagnosis of uterine perforation can lead to bleeding, infection and death of the woman. Uterine ruptures during childbirth, as well as during pregnancy, can occur in women who have previously suffered uterine trauma (suturing a hole in the uterus, cesarean section, enucleation of nodes due to fibroids), abortions, inflammatory processes in the postpartum and post-abortion periods, who have incomplete uterine muscle ( infantile or women who have given birth many times). Proper management of childbirth involves timely diagnosis of the threat of injury to the woman’s genital organs, on the basis of which delivery tactics are chosen that prevent the occurrence of severe complications. Treatment of injuries is carried out mainly surgically. After discharge from a medical institution, a visit to the antenatal clinic is necessary 10-12 days and 1.5-2 months after birth. If unhealed injuries are detected, plastic surgery is performed. It is necessary to limit sexual intercourse for some time; after 2-3 months, sexual life is fully restored. Prevention of genital injury during abortion is the use of contraceptives.
Damage to the penis is most often localized in the area of ​​the foreskin, glans, cavernous bodies, and can be combined with damage to the scrotum. Ruptures or tears of the penile frenulum occur during sexual intercourse in men with a short frenulum and are accompanied by pain and bleeding, which sometimes requires surgical intervention. When the penis gets into moving mechanisms, usually through clothing, extensive scalp wounds most often occur, extending to the scrotum, accompanied by intense pain and even traumatic shock, and significant bleeding is not uncommon. In this case, complete tearing of the skin of the scrotum and penis is possible. In this case, a large skin defect is formed, which is mainly associated with all treatment problems. It is important to deliver scalped skin to a medical institution, otherwise the defect on the penis is covered by the skin of the anterior abdominal wall, and the testicles are buried under the skin of the thighs. Cutting, puncturing or biting wounds to the penis are common. Superficial wounds that do not reach the tunica albuginea are accompanied by minor bleeding; in case of damage to the cavernous bodies, heavy, life-threatening bleeding and shock develop. When one of the corpora cavernosa is crossed, the penis tends to bend in the opposite direction. Injuries to the head of the penis, and they can occur during ritual circumcisions, vary in degree, up to its complete amputation.
First aid for a wound consists of applying an aseptic pressure bandage to the penis and, if possible, a rubber tourniquet (even using a handkerchief). In case of complete traumatic amputation of the penis, the severed organ must be preserved (during the first 24 hours it can be sewn into the stump). Wounds to the foreskin require sutures or circumcision. If the penis is bruised, the tunica albuginea of ​​the corpora cavernosa does not rupture; damage to the urethra is possible. The bruise is accompanied by severe pain in the penis, an increase in its size, swelling, and hematoma. Therapeutic measures include the prescription of cold, rest, preventive therapy, and means to prevent erection.
Subcutaneous rupture of the corpora cavernosa or fracture of the penis is possible during an erection and most often occurs during rough sexual intercourse as a result of rapid and intense bending of the penis when resting on the woman’s pubic bones. A characteristic crack that is heard is associated with a fracture; there may be a rupture of one cavernous body or both. Internal bleeding begins, pain increases intensely, and shock is possible. Treatment for rupture is surgical; the penis is splinted and tied to the abdomen. Subsequently, surgical correction of copulatory function disorders is carried out. Dislocation of the penis occurs against the background of an erection under conditions similar to those of a fracture, due to rupture of the ligaments that fix the penis to the pelvic bones. In this case, the corpora cavernosa are displaced under the skin of the scrotum and perineum (the penis is palpated in the form of an empty sac). After repositioning the penis, sutures are placed on the torn ligaments.
Pinching of the penis occurs when various rings, nuts, ropes, rubber, wire, etc. are put on it. The injury is caused by the victims themselves to achieve an erection, to prevent bedwetting, by the mentally ill, and also by sexual partners. Due to poor circulation, swelling of the penis, pain and acute urinary retention develop. Treatment consists of removing the compressing objects. Prolonged pinching can lead to gangrene of the penis.
Damage to the scrotum and its organs most often occurs due to a direct blow to the scrotum and its compression due to rubble, car accidents, sports and other types of injuries. A special feature of a scrotal injury is the rapid onset of edema with engulfment of the penis, often covering it completely. In case of severe injury with rupture of the testicle or spermatic cord, shock and internal bleeding may develop, manifested by general weakness, pallor of the skin, drop in blood pressure, etc. With open injuries to the scrotum, testicular prolapse is possible. Treatment of scrotal injuries with or without damage to its organs is mainly surgical; even a relatively small deep hematoma can lead to compression of the vessels and nerves of the spermatic cord, to trophic disorders and the occurrence of testicular hypotrophy.
In children, against the background of sudden movements, jumps, falls, testicular torsion may be observed, which occurs due to underdevelopment of the ligament that fixes the testicle to the bottom of the scrotum, which is manifested by its excessive mobility. With torsion, blood circulation is sharply disrupted, sharp pain, vomiting, and swelling of the corresponding half of the scrotum appear. Urgent surgery is necessary; late treatment is the cause of testicular gangrene, which requires its removal.

Injuries to the genital organs develop as a result of falls, especially on sharp and piercing objects, during sexual intercourse, when hard and sharp objects and instruments are inserted into the vagina and uterine cavity (bougies, metal catheters, dilators, etc.).

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

Injuries resulting from a fall on sharp, piercing objects during sexual intercourse usually represent lacerations with extensive damage to the walls, and often the vault of the vagina, with the formation of hematomas spreading to the pelvic tissue. Perforation of the vaginal vault with sharp instruments is also accompanied by the formation of stab and laceration wounds. In this case, damage to the pelvic organs - bladder, intestines - is possible. Damage to the upper third of the vagina is also usually accompanied by significant bleeding.

The clinical picture of pelvic injuries is varied: depending on the severity of the injury, the condition of patients can be from satisfactory to collapsed. From the genital tract, bleeding ranges from slight to severe. In case of injury to the external genitalia, examination reveals crush injuries, ruptures, and hematomas. The diagnosis is clarified when collecting anamnesis (indications for the introduction of instruments for fetal expulsion, etc.).

At the prehospital stage, in case of heavy bleeding from wound sites on the external genitalia, the application of a pressure T-shaped bandage is indicated. In case of massive blood loss or shock, the administration of blood replacement solutions, vitamins (ascorbic acid), and cardiac medications should be urgently started. The same treatment continues while the patient is being transported.

In all cases of genital trauma, urgent hospitalization to the gynecological department is required. Since without a special gynecological examination it is difficult to correctly assess the severity of the injury, the patient must be hospitalized on a stretcher and transferred directly to the hospital doctor.

Treatment of genital injuries is usually surgical. It consists of careful treatment of the wound, stopping bleeding by ligating blood vessels or using tamponade. The rupture is sutured less often (provided the wound is fresh, “uncontaminated”). For injuries penetrating the vaginal vault, laparotomy is indicated. At the same time, anti-shock measures are performed, anti-tetanus serum is administered, and the inflammatory process is prevented and treated.

Damage to female genital organs

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

1. ruptures during sexual intercourse;
2. damage caused by foreign bodies in the genital tract;
3. injury to the external genitalia and vagina of a domestic or industrial nature caused by any sharp object;
4. genital bruises, crush marks;
5. stab, cut and gunshot wounds of the genitals; damage due to medical activities.

Regardless of the cause of the damage, determining its volume requires a thorough examination in a hospital setting, which includes, along with the initial examination, special methods (rectoscopy, cystoscopy, radiography, ultrasonography and nuclear magnetic resonance imaging, etc.).

The varied nature of injuries and complaints, many variants of the course of the disease depending on age, constitution and other factors require individual medical tactics. Knowledge of generally accepted tactical decisions allows the emergency physician to begin emergency measures at the prehospital stage, which will then be continued in the hospital.

Damage to the female genital organs associated with sexual intercourse. The main diagnostic sign of injury to the external genitalia and vagina is bleeding, which is especially dangerous when the cavernous bodies of the clitoris (corpus cavernosus clitoridis) are damaged. Rarely, the cause of bleeding requiring surgical hemostasis can be a rupture of the fleshy vaginal septum. Usually one or more sutures are placed on the vessels, injected with novocaine and adrenaline hydrochloride. Sometimes short-term pressure on the vessel is enough.

With hypoplasia of the external genitalia, their atrophy in older women, as well as in the presence of scars after injuries and ulcers of inflammatory origin, the rupture of the vaginal mucosa can extend deeper into the external genitalia, urethra and perineum. In these cases, a surgical suture will be required to achieve hemostasis.

Vaginal ruptures can occur due to an abnormal position of the woman’s body during sexual intercourse, violent sexual intercourse, especially in a state of intoxication, as well as when foreign objects are used in violence, etc. A typical injury in such circumstances is a rupture of the vaginal vaults.

Doctors often observe extensive damage to the external genitalia and adjacent organs. Forensic practice abounds in such observations, especially when examining minors who have been raped. Characterized by extensive ruptures of the vagina, rectum, vaginal vaults, up to penetration into the abdominal cavity and intestinal prolapse. In some cases, the bladder is damaged. Delayed diagnosis of vaginal ruptures can lead to anemia, peritonitis and sepsis.

Injuries to the pelvic organs are diagnosed only in a specialized institution, therefore, at the slightest suspicion of injury, patients are hospitalized in a hospital.

Damage due to penetration of foreign bodies into the genital tract. Foreign bodies introduced into the genital tract can cause serious problems. From the genital tract, foreign bodies of various shapes can penetrate into adjacent organs, pelvic tissue and the abdominal cavity. Depending on the circumstances and purpose for which foreign bodies were introduced into the genital tract, the nature of the damage may vary. There are 2 groups of damaging objects:

1. introduced for medicinal purposes;
2. introduced for the purpose of producing a medical or criminal abortion.

The list of circumstances and causes of damage to the genital tract at the everyday level can be significantly expanded: from small objects, often of plant origin (beans, peas, sunflower seeds, pumpkins, etc.), which children hide during games, and modern vibrators for masturbation to random large objects used for the purposes of violence and hooliganism.

If it is known that the damaging object did not have sharp ends or cutting edges, and manipulations are stopped immediately, then you can limit yourself to observing the patient.

The leading symptoms of genital trauma: pain, bleeding, shock, fever, leakage of urine and intestinal contents from the genital tract. If the damage occurred in an out-of-hospital setting, then of the two decisions - to operate or not to operate - the first is chosen, since this will save the patient from fatal complications.

The only correct solution would be hospitalization. Moreover, due to the unclear nature and extent of the injury, even in the presence of severe pain, anesthesia is contraindicated.

Many difficulties associated with the provision of ambulance and emergency medical care for trauma, blood loss and shock can be successfully overcome if, in the interests of continuity at the stages of medical evacuation, the ambulance team, when deciding to transport the patient, transmits information about this to the hospital where the patient will be delivered.

Injury to the external genitalia and vagina of a domestic or industrial nature caused by any sharp object. Damage of this nature is caused by various reasons, for example, falling on a sharp object, attack by cattle, etc. There is a known case when, while skiing from a mountain, a girl ran into a stump with sharp branches. In addition to the fracture of the ischial bones, she had multiple injuries to the pelvic organs.

A wounding object can penetrate the genitals directly through the vagina, perineum, rectum, abdominal wall, damaging the genitals and adjacent organs (intestines, bladder and urethra, large vessels). The variety of injuries corresponds to their multisymptoms. It is significant that under the same conditions, some victims develop pain, bleeding and shock, while others do not even experience dizziness and get to the hospital on their own.

The main danger is injury to internal organs, blood vessels and contamination of the wound. This can be detected already during the initial examination, noting the leakage of urine, intestinal contents and blood from the wound. However, despite the large volume of damage and involvement of the arteries, in some cases the bleeding may be insignificant, apparently due to crushing of the tissue.

If, during a prehospital examination, an object that caused injury is found in the genital tract, it should not be removed, as this may increase bleeding.

Bruises of the genital organs, crushing. These injuries can occur, for example, in traffic accidents. Large hemorrhages, even open wounds, can form in tissues compressed by two moving hard objects (for example, in the soft tissue of the vulva relative to the underlying pubic bone under the influence of a hard object).

A feature of bruised wounds is the large depth of damage with a relatively small size. The threat is posed by damage to the cavernous bodies of the clitoris - a source of severe bleeding, which is difficult to undergo surgical hemostasis due to additional blood loss from the places where clamps are applied, needle pricks and even ligatures.

Long-term pressing of the injury site to the underlying bone may not give the expected results, but it is still used during transportation to the hospital.

Bleeding may also be accompanied by an attempt to achieve hemostasis by injecting a bleeding wound with a solution of novocaine and adrenaline hydrochloride. It should be borne in mind that damage to the external genitalia due to blunt force trauma is more often observed in pregnant women, which is probably due to increased blood supply and varicose veins under the influence of sex hormones.

Under the influence of trauma with a blunt object, subcutaneous hematomas can occur, and if the venous plexus of the vagina is damaged, hematomas are formed that spread in the direction of the ischiorectal recess (fossa ischiorectalis) and the perineum (on one or both sides).

Vast cellular spaces can accommodate a significant volume of flowing blood. In this case, blood loss is indicated by hemodynamic disorders up to shock.

Damage to the external genitalia may be accompanied by injury to adjacent organs (polytrauma), in particular fractures of the pelvic bones. In this case, very complex combined injuries can occur, for example, rupture of the urethra, separation of the vaginal tube from the vestibule (vestibulum vulvae), often with damage to the internal genital organs (separation of the uterus from the vaginal vault, formation of hematomas, etc.).

In case of polytrauma, it is rarely possible to avoid transection and limit oneself to conservative measures. The multiple nature of the injuries is an indication for emergency hospitalization in the surgical department of a multidisciplinary hospital.

Stab, cut and bullet wounds of the genitals are described in violent acts against a person on sexual grounds. These are usually simple wounds with cut edges. They can be superficial or deep (the internal genital and adjacent organs are damaged). The topography of the internal genital organs is such that it provides them with fairly reliable protection. Only during pregnancy, the genital organs, extending beyond the pelvis, lose this protection and can be damaged along with other abdominal organs.

There are almost no comprehensive statistical data regarding the frequency of bullet injuries to the internal genital organs, but in modern conditions women can become victims of violence. Therefore, this type of injury is not completely excluded in the practice of an emergency physician.

The experience of military conflicts has shown that the majority of wounded women with damage to the pelvic organs die in the prehospital stage from bleeding and shock. Bullet wounds are not always assessed adequately. The task is easier with a through wound. If there are entrance and exit openings of the wound canal, it is not difficult to imagine its direction and the likely extent of damage to the internal genital organs. The situation is completely different when there is a blind bullet wound.

When making a decision, the emergency physician must proceed from the assumption that the injury caused multiple injuries to internal organs until the contrary is proven. In this regard, it is most appropriate to hospitalize the wounded woman in a multidisciplinary hospital with urgent surgical and gynecological departments.

Bullet wounds are especially dangerous during pregnancy. Injuries to the uterus usually cause significant blood loss. An injured pregnant woman must be hospitalized in the obstetric department of a multidisciplinary hospital.

Conditions requiring emergency care in obstetrics and gynecology

Often, the provision of emergency and emergency medical care is required by physiological processes, in particular childbirth. Planned hospitalization in maternity hospitals covers no more than 30% of women carrying a pregnancy to term; In 70% of cases, labor occurs at home, of which in 0.5–0.7% of women, labor begins before the arrival of the ambulance team or is completed with its participation. Most “home” births are classified as rapid births, associated with high trauma, large blood loss and a threat to the life of the fetus and newborn.

Features of the course of pathology of the abdominal organs, included in the category of “acute” abdomen, during pregnancy. The emergency doctor who is the first to assess the condition of a pregnant woman should be well aware of the numerous combinations of pregnancy and “pregnancy diseases” that significantly aggravate each other.

The mortality rate of pregnant women is higher than that of non-pregnant women (in case of acute appendicitis - 2-2.5 times, in case of intestinal obstruction - 2-4 times).

In addition to the increased danger for the mother, acute diseases of the abdominal organs adversely affect the course of pregnancy, causing:

• premature termination of pregnancy;
• fetal death;
• death of a newborn.

With peritonitis, newborn mortality reaches 90%, with appendicitis - 5-7%, with intestinal obstruction - 70%.

The prognosis for the mother and fetus in any acute diseases of the abdominal organs worsens significantly with increasing pregnancy and childbirth, which is associated with increasing diagnostic difficulties and, consequently, a delay in surgery.

Symptoms of an “acute” abdomen in the early stages of pregnancy are typical.

In the later stages and during childbirth, they can be erased for a number of reasons:

• significant changes in the topography of internal organs;
• stretching of the abdominal wall and peritoneum;
• inaccessibility for palpation of individual organs pushed aside by the uterus.

The main reason is a change in the reactivity of the pregnant woman’s body. An “acute” abdomen during pregnancy should be considered as a direct threat to the life of the mother and fetus. Diagnostics, primary care at the prehospital stage, surgical treatment and management of the patient in the postoperative period require joint actions of emergency physicians, obstetricians-gynecologists and surgeons.

The order of the operation and its volume depend on the stage of pregnancy. In the early stages, an operation is performed to eliminate the causes that caused the “acute” abdomen.

In the later stages, in addition to eliminating the causes that caused the “acute” abdomen, the need for delivery arises.

Acute appendicitis and pregnancy. Pathognomonic signs of acute appendicitis are observed.

TREATMENT surgical, regardless of the stage of pregnancy. If it is necessary to maintain pregnancy, appropriate therapy is indicated taking into account the duration of pregnancy. It is carried out against the background of antibiotic therapy.

Intestinal obstruction and pregnancy. Dynamic intestinal obstruction can be caused by the administration of the corpus luteum hormone. Due to disruption of the processes of its transformation into pregnanediol and excretion from the body, intestinal atony and intestinal obstruction develop.

Intestinal obstruction can occur when the uterus leaves the pelvic cavity (3-4th month of pregnancy), lowers the head to the entrance to the pelvis (end of pregnancy), a sudden decrease in the volume of the uterus after childbirth and a rapid change in intra-abdominal pressure.

Acute pancreatitis and pregnancy. Acute pancreatitis during this period is characterized by a severe course, high maternal and antenatal mortality. If it occurs before 12 weeks, termination of pregnancy is indicated.

Liver and gallbladder diseases and pregnancy. All indolent hepatitis worsens during pregnancy. Infectious agents that cause hepatitis are diverse and require fairly accurate identification. Specific treatment is prescribed.

Gallstone disease (cholelithiasis) can worsen at any stage of pregnancy. Surgical treatment may be necessary.

Chronic cholecystitis. Frequent exacerbations are possible during pregnancy. Pregnant women are prescribed an appropriate diet, antispasmodics and choleretic agents. It must be taken into account that pregnancy itself contributes to cholestasis and cholelithiasis, which is caused by increased cholesterol in the blood and difficulty in the outflow of bile.

Peptic ulcer disease and pregnancy. During pregnancy, there is a decrease in the secretory and motor functions of the digestive canal, and the development of protective inhibition relieves psycho-emotional stress. Therefore, pregnant women usually experience remission of peptic ulcer disease.

Sometimes there is a sharp exacerbation of peptic ulcer disease in the early stages of pregnancy, against the background of severe early toxicosis of pregnant women. In such a situation, a pregnant woman (often with severe exacerbation and jaundice) must be hospitalized in the gynecological department. The pregnancy is interrupted, an intensive course of rehydration and antiulcer therapy are carried out. Repeated pregnancy is possible only in the stage of stable remission.

Perforated ulcers of the stomach and duodenum often develop after cesarean section. It is also necessary to note the significant increase in so-called stress ulcers, for which only surgical treatment is indicated.

The doctor needs to decide the issue of the patient’s transportability. During the period of expulsion, the doctor must provide assistance to the woman in labor and the newborn and, after the completion of the placental period, transport both to the observation department of the nearest maternity hospital.

To ensure continuity at all stages of evacuation and guaranteed assistance in a short time, the emergency physician is obliged to:

1. Using dispatch communication, warn the hospital where the sick woman in labor will be delivered about the impending transportation and report a preliminary diagnosis.
2. Give the woman in labor a functionally advantageous position and begin adequate treatment with available means.

Diagnosis of conditions that are the reason for seeking emergency help is difficult, limited by time, and requires the doctor to have sufficient knowledge of the functions of the female body and the characteristics of the pathology associated with age and gender. For example, pain in the heart area is included in the symptom complex of acute blood loss, but in women over 40 years of age it is necessary to exclude both acute or chronic ischemic heart disease and internal bleeding due to peptic ulcer disease, Mallory-Weiss syndrome, cirrhosis of the liver, or splenic rupture. On the contrary, pain in the heart area in young women, tachycardia, severe pallor, cold sweat, dizziness, darkening of the eyes, frequent weak pulse, arterial hypotension with a corresponding history (delayed menstruation) force one to think about a disturbed ectopic pregnancy. Cramping pain in combination with bleeding, with an appropriate history, may indicate an interrupted pregnancy (uterine or tubal) or a developing fibromatous node. Acute pain, bleeding from the genital tract, and shock can occur with various injuries. Monthly recurring “morphine” pain in the second phase of the cycle, due to which the patient has to consult an emergency doctor more than once, most likely indicates endometriosis. The connection between the symptom of pain and acute and chronic inflammatory process in the genital organs, ovarian apoplexy, rupture of the cyst capsule after coitus or vigorous gynecological examination, torsion of the pedicle of the ovarian tumor, necrosis of the fibromatous node, etc. is quite obvious. In many patients, pain is the leading complaint with which they go to the antenatal clinic, and the main reason for long-term outpatient treatment. In some patients, an acute increase in one or more symptoms, including pain, is an indication for hospitalization. Below is a list of diseases and pathological conditions that require emergency care at the prehospital stage and during transportation of the patient.

BLEEDING DUE TO INJURY OF THE FEMALE GENITAL ORGANS

Bleeding can occur during defloration during the first sexual intercourse (usually such bleeding is not profuse), as well as with bruises and wounds as a result of a fall, blow, etc. Symptoms When the hymen ruptures, the patient complains of bleeding from the genital tract and pain at the vaginal opening. When examining the vestibule of the vagina, tissue swelling and bleeding from the torn hymen are noted. With bruises and injuries to the external genitalia, external bleeding most often occurs due to damage to the clitoral area (bleeding can be profuse). Traumatic injury can be manifested by the development of a hematoma in the area of ​​the external genital organs, while there is no external bleeding, and the patient complains of bursting pain and the inability to sit. Urgent Care. Local application of cold (ice pack on the external genital area), rest, painkillers (1 ml of 50% analgin intramuscularly or 1 ml of 1% promedol solution subcutaneously). A pressure bandage is applied to the external genitalia, and vaginal tamponade is less often necessary. Hospitalization. In case of severe bleeding from a deep rupture of the hymen, in case of injury to the clitoris, as well as in case of increasing hematoma of the external genital organs with damage to surrounding tissues, hospitalization in a gynecological or surgical department is necessary.

In most cases, we have to deal with manifestations of mechanical trauma, associated mainly with falling on blunt and sharp objects, blows, sometimes with the introduction of foreign bodies into the vagina or urethra (parts of fountain pens, hairpins, pins, etc.), masturbation, attempts to have sexual intercourse intercourse or rape, as well as injuries to the genitals at work, during physical education and sports, as a result of road accidents, etc. Most often, the vulva, perineum, vaginal walls, penis, scrotum and its organs are damaged; in women of childbearing age, damage is mainly associated with gross defloration, abortion and childbirth.

Damage to the vulva with the formation of a hematoma often occurs after childbirth, less often due to a blow or fall on a blunt object. There is pain, tension, and difficulty walking. Treatment is mainly conservative (bed rest, cold, hemostatic agents, etc.), followed by resorption therapy. If the hematoma grows or suppurates, hospitalization is necessary. Damage to the clitoris usually occurs as a result of domestic trauma or childbirth and is accompanied by severe bleeding, sometimes life-threatening. Swelling and hematoma occur in the perineum and in the labia area; in some cases, when the wound becomes infected, the temperature rises, pallor, cold sweat appear, blood in the urine, pain when urinating, and involuntary passage of gas and feces may occur. A sterile pressure bandage and an ice pack are applied to the area of ​​the external genitalia. Treatment consists of suturing the mucous membrane over the clitoris. Tears of the hymen outside of sexual intercourse, as a rule, do not reach the base of the hymen, are located close to the perineum, posteriorly towards the scaphoid fossa, where natural notches almost never occur. Usually accompanied by minor pain and bleeding that stops quickly; healing occurs within 7-10 days, complications are not uncommon. Damage to the tissues of the perineum, vagina and cervix often occurs during childbirth. They can be observed in the form of superficial abrasions and cracks, often ruptures. The occurrence of perineal ruptures, which more often occur in primiparous women, is facilitated by insufficient elasticity (rigidity) of tissues in primiparous women over 30 years of age, scars after previous births, structural features (high perineum), as well as a large fetus, excessively dense fetal skull bones in post-term pregnancy , the use of obstetric forceps, etc. Vaginal ruptures occur with insufficient extensibility of its walls, a narrow vagina, a large fetal head, rapid or protracted labor; may be a continuation of the perineal rupture. Lacerations of the vagina and perineum predispose to the occurrence of prolapse and prolapse of the genital organs; unrepaired injuries or ruptures, the suturing of which was performed technically incorrectly, are especially dangerous. Cervical ruptures are most often observed during childbirth in the form of shallow tears at its edges and are not accompanied by bleeding. During pathological childbirth, cervical ruptures occur, accompanied by significant bleeding and other pathological consequences. Cervical erosion, endocervicitis, ruptures during previous abortions, childbirth, excessive density, inflexibility of the cervix, as well as surgical intervention during childbirth, etc. contribute to the occurrence of ruptures. Unsutured ruptures become infected, and a postpartum ulcer forms in the wound area, which is a source of further spread of infection. During the healing process of an unsutured rupture, scars are formed that contribute to cervical eversion. Cervical inversion predisposes to chronic inflammation of the mucous membrane and erosion of the cervix, sometimes leading to the occurrence of precancerous diseases and cervical cancer (see Tumors of the genital organs).

Cervical ruptures can occur not only during childbirth, but also during artificial termination of pregnancy, especially in nulliparous women. Trauma to the uterus can occur during induced abortion, childbirth and is a severe obstetric and gynecological pathology. The possibility of perforation of the uterus during an abortion is caused by the use of sharp surgical instruments during one walkie-talkie virtually “blindly”. The risk of this complication increases with pregnancy 11-12 weeks, as well as with criminal abortion. Delayed diagnosis of uterine perforation can lead to bleeding, infection and death of the woman. Uterine ruptures during childbirth, as well as during pregnancy, can occur in women who have previously suffered uterine trauma (suturing a hole in the uterus, cesarean section, enucleation of nodes due to fibroids), abortions, inflammatory processes in the postpartum and post-abortion periods, who have incomplete uterine muscle ( infantile or women who have given birth many times). Proper management of childbirth involves timely diagnosis of the threat of injury to the woman’s genital organs, on the basis of which delivery tactics are chosen that prevent the occurrence of severe complications. Treatment of injuries is carried out mainly surgically. After discharge from a medical institution, a visit to the antenatal clinic is necessary 10-12 days and 1.5-2 months after birth. If unhealed injuries are detected, plastic surgery is performed. It is necessary to limit sexual intercourse for some time; after 2-3 months, sexual life is fully restored. Prevention of genital injuries during abortion is the use of