S. Gambhir1, A. Grigorian1, V. Gabriel1, S. Schubl1, C. Barrios1, N. Bernal1, J. Victor1, J. Nahmias1 1University Of California – Irvine,Surgery,Orange, CA, USA
Introduction: Vaginal and vulvar trauma may occur accidentally or because of an act of violence. Due to its rarity, little is known about risk factors effecting need for operative repair. We sought to perform a large database analysis of adult external genitalia to determine possible risk factors for requiring operative repair.
Methods: A retrospective analysis of the National Trauma Data Bank was performed between 2007-2015. Patients ≥ 16 years old with vaginal or vulvar trauma were identified. Risk factors for surgical repair were identified using a multivariate logistic regression analysis.
Results: From 2,040,235 female patients, 2,445 (<0.2%) were identified to have external genitalia trauma with the majority being injury to the vagina (68.6%). In patients with injury to the vagina, age≥65 (OR=0.41, CI=0.26-0.62, p<0.001), injury severity score (ISS) ≥ 25 (OR=0.66, CI=0.50-0.86, p<0.05) or victims of rape (OR=0.39, 95% CI=0.26-0.57, p<0.001) were less likely to require repair. In patients with injury to the vulva, age≥65 (OR=0.45, CI=0.21-0.94, p<0.05), victims of rape (OR=0.26, CI=0.08-0.87, p<0.05) or gunshot violence (OR=0.10, CI=0.02-0.59, p<0.05) were less likely to require repair but those with a concomitant injury to the vagina were more likely to require repair (OR=2.56, CI=1.63-4.03, p<0.001).
Conclusion: Injuries to the vagina or vulva occur in < 0.2% of traumas. Interestingly, in both vulvar and vaginal trauma, age≥65, ISS≥25 and involvement in rape or gunshot violence was associated with lower risk for operative intervention. A combined injury to the vagina and vulva increases the need for repair.