Genital Injury

First aid for a genital injury

1. Stop bleeding with firm, steady pressure using a clean cloth for 10 minutes. Do not keep lifting it to check.
2. Apply cold: a cold pack or ice wrapped in a cloth, 15 to 20 minutes at a time, several times in the first 48 hours. Never apply ice directly to genital skin.
3. Support the area: for the scrotum, snug briefs or an athletic supporter; lie down with a rolled towel under the scrotum.
4. Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose. Do not give aspirin to children or teenagers.
5. Check urination. If you cannot pass urine, or there is blood in it or at the opening, go to the ER and do not attempt to insert a catheter.
6. Zipper entrapment: do not pull. Cut the zipper's bottom bar or the fabric to release it, or go to urgent care, where it can be freed under local anesthetic.
7. Do not wash or change clothes after a sexual assault if you might want forensic evidence collected.

Injuries to the testicles and scrotum

The testicles are mobile, which protects them, but a direct blow against the pubic bone can cause:

• Contusion: bruising and pain that settle over days.
• Hematocele: blood collecting around the testicle, causing a swollen, dark scrotum.
• Testicular rupture: a tear in the tough outer layer (tunica albuginea). Ultrasound finds it. Surgery within 72 hours saves the testicle in most cases; delay often means removal.
• Torsion after trauma: a blow can trigger testicular torsion, a twist of the blood supply that needs surgery within hours.

Pain that persists more than an hour, nausea and vomiting, or a testicle that sits high or horizontally needs urgent evaluation. Our page on testicle pain covers non-injury causes.

Injuries to the penis

• Penile fracture: rupture of the erectile chambers during vigorous sex or bending an erect penis. Classic signs are a crack, immediate loss of erection, rapid swelling and a bruised "eggplant" appearance. Prompt surgical repair lowers the risk of curvature and erectile dysfunction.
• Urethral injury: suspected with blood at the tip, difficulty urinating or a straddle fall onto the perineum. Doctors image the urethra before any catheter is passed.
• Cuts, bites and zipper injuries: cleaned and closed; bites need antibiotics.
• Constriction injuries: rings or bands left on too long cause swelling and can cut off blood flow. Remove them in the ER if they do not come off easily.

Injuries to the vulva and vagina

• Straddle injuries in girls (bike bars, pool edges, furniture) usually bruise or cut the labia. A vulvar hematoma, a tense purple swelling, can be very painful and sometimes needs drainage.
• Vaginal tears can follow first intercourse, consensual or forced sex, objects or water-skiing accidents. Deep or bleeding tears need repair under anesthesia.
• Penetrating injuries may reach the bladder, rectum or abdomen and always need emergency assessment.

Sexual assault and suspected abuse

Genital injury after sexual assault needs both medical care and support, whatever the visible injuries. An ER can provide a forensic exam (often by a trained SANE nurse), treatment of injuries, emergency contraception, and medicines to prevent HIV and other infections, which work best within 72 hours. You do not have to report to the police to get care. In the US, the RAINN hotline (1-800-656-4673) connects you to local help.

In children, a genital injury that does not fit the explanation, comes with other injuries, or is accompanied by discharge or an STI should be evaluated for abuse.

How doctors assess genital injuries

• History: what happened, when, the force involved, and whether you can urinate.
• Examination: of the genitals, perineum, pelvis and abdomen. Children and some adults are examined under sedation or anesthesia for comfort and accuracy.
• Urine test for blood.
• Scrotal ultrasound: checks for testicular rupture and blood flow.
• Retrograde urethrogram: dye X-ray of the urethra when injury is suspected.
• CT scan if pelvic fracture or bladder injury is possible. Learn more about pelvic fracture and bladder injury.

Treatment and recovery

Genital tissues have a rich blood supply and heal quickly. Avoid sex, cycling and contact sports until pain and swelling have settled and your doctor clears you.

Possible complications

• Infection of wounds or hematomas
• Loss of a testicle, or reduced fertility after severe testicular injury
• Penile curvature, painful erections or erectile dysfunction after penile fracture
• Urethral stricture, causing a weak or sprayed stream months later
• Painful scarring of the vulva or vagina, or pain with sex

Prevention

Wear a protective cup in contact sports and baseball, check bikes are the right size for children, avoid bending an erect penis forcefully, and use lubrication during sex.

Frequently asked questions

When should I go to the ER for a genital injury?

Go if you cannot pass urine or see blood in the urine or at the opening, if the scrotum swells rapidly or testicle pain lasts more than an hour, if the penis cracked and swelled during sex, or if bleeding does not stop with 10 minutes of pressure.

How long does testicle pain last after being hit?

Ordinary pain from a blow usually eases within an hour, though aching and mild bruising may last a few days. Severe pain lasting more than an hour, nausea, a swollen or discolored scrotum, or a testicle in an unusual position needs urgent ultrasound to rule out rupture or torsion.

What is a straddle injury?

A straddle injury happens when you fall astride something hard, such as a bike crossbar, fence or pool edge, crushing the genitals and perineum against the pubic bone. It can bruise or cut the vulva or scrotum, and in boys and men can tear the urethra.

Can a genital injury affect fertility?

Most cannot. A severe testicular injury, particularly a rupture that is not repaired quickly, can reduce sperm production or lead to loss of the testicle. One healthy testicle is usually enough for normal fertility. Vulvar and vaginal injuries rarely affect fertility.

Does a vulvar hematoma need treatment?

Small hematomas usually settle with cold packs, rest and pain relief over 1 to 3 weeks. A large, expanding or very painful hematoma, or one that makes urination difficult, may need surgical drainage, so see a doctor promptly if swelling keeps growing.