Male genital injuries treated at a tertiary hospital in the western region of Nepal: A two-year snapshot.

Background: Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic intervention may lead to loss of fertility due to infections and anatomical disruption of normalcy. This study highlights the clinical scenarios, etiology and outcome of male genital injury cases that were managed at a tertiary care center in Nepal. Such injuries are not frequently encountered as patients are hesitant to report such injuries. The present study is the first from Nepal which depicts a comprehensive report on male genital injuries. Methods: A retrospective analysis of discharge summaries of the cases of male genital injuries was reviewed during June 2020. All the treated cases during the two-year period from April 2018 to April 2020 at Lumbini Medical College, Nepal were included in the study. Results: There were eight cases of genital trauma admitted and treated during the study period. All the patients were males and age ranged from six to 71 years with a mean age of 33 ± 21.45 years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause in the majority of cases. Conclusion: Superficial injuries to the penis and scrotum do not require surgical exploration and could be managed conservatively. However, deeper and complicated injuries, testicular preservation, the functionality of the part and cosmetic issues are taken into consideration which might require a multi-disciplinary approach. Apart from the medical issues pertaining to genital injuries, there are legal and psychological aspects of such events too which should not be ignored.

Physical and Biological Evidence in Sexual Assault Cases Reported in District Rawalpindi

Forensic medical examination serve two purposes i.e.to preserve mental and physical health of the victim as well as collection of forensic evidence 1,2. Collection and documentation of evidence whether in form of injures or biological material is help to validate the objects and the accoster's past.3 The outline of wounds also has a criminal worth because they are related to the result of lawful proceedings4. The works assessment explores the variables linked to genital harm occurrence and places that are informed in a sequence of surveying examinations of medicinal proceedings 5.The occurrence of perfect indication of erotic harms in the U.S. ranges from 5-27%, in Italy 11.5%, in Thailand 42% and in Denmark 38%. In Israel, as in another place in the countries, few cases of erotic stabbing in children have vibrant indication of a erotic style. 6,7,8,9. Objective: To evaluate incidence and comparison of physical and biological evidence in victims of sexual assault and their relation to time interval between examination and incident. Methodology: The retrospective cross sectional study was placed during June 2019 to December 2020 on cases reported in the DHQ Hospital Rawalpindi with follow up reports. Total 108 cases were reported during this period. Data was collected from DHQ Hospital Rawalpindi with follow up reports. Examination results were included presence and absence of physical injuries located genital region and other parts of the body, and presence and absence of biological evidence .The fallouts of investigation were linked to parameters such as sex, age and length of time since assault. Data was analyzed by using SPSS version 19 Results: Female victim: Out of 108 cases 77 was female.61% was unmarried and 39% was married (Figure 1). 44.2% cases was fall between age range of 16-20years.2.6%cases between age group of 45-50 years.51.9% cases belong to rural area. While 48.1% cases belong to urban. Vaginal swab was positive in 79.2%.genital injuries was present in 13% cases.11.7% married and 1.3% unmarried. Other injuries present in 6.5%married.7.8%unmarried. Fresh hymen injuries present in 13%.old in 41.6%. Male victims: Total 31 in number.67.7%in rural area ,while 32.3% in urban.45.2% (14)between age group 11-15 years .Anal swab was positive in 64.5%.(20 in number).Bleeding was present in 32.3% (10)cases. Bruises in 41.9%.abrasion was present in 48.4%.(15)25% in 11-15 years age group. Genital injuries was present in 45.2%(14).other injuries 28.1%.anal swab with injuries positive in 34.4%.negative in 12.5%.Finding on clothes was present on 12.5%. Conclusion & Recommendations: Rape or sexual assault in the absence of prior sexy knowledge, genital or physique harms are usually found in adolescents. The possibility of rape in nonappearance of any hurt, with or deprived of permission cannot be excluded. A competent forensic examiner must examines and follow up the victims of sexual violence. The forensic examiner must have technical and scientific skills that are medicinal and stabbing history taking, whole body examination, and organic article collects, recording damages, clinical pediatric practice, interpretation of findings and reports and prosecution. Keywords: Genital harms, adolescent, body injuries, Prosecution

Male genital injuries attending a tertiary hospital in a western region of Nepal: A two-year snapshot.

Background: Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic intervention may lead to chances of loss of fertility due to infections and anatomical disruption of normalcy. This study highlights the clinical scenarios, etiology and outcome of male genital injury cases that were managed at a tertiary care center in Nepal. Such injuries are not frequently encountered as lack of reporting by patients means cases are rare. The present study is the first from Nepal which depicts a comprehensive report on male genital injuries. Methods: A retrospective analysis of discharge summaries was carried out and the cases of male genital injuries were reviewed during June 2020. All the treated cases during the two-year period from April 2018 to April 2020 at Lumbini Medical College, Nepal were included in the study. Results: There were eight cases of genital trauma admitted and treated during the study period. All the patients were males and age ranged from six to 71 years with a mean age of 33 ± 21.45 years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause in the majority of cases. Conclusion: Superficial injuries to the penis and scrotum do not require surgical exploration and could be managed conservatively. However, deeper and complicated injuries, testicular preservation, the functionality of the part and cosmetic issues are taken into consideration which might require a multi-disciplinary approach. Apart from the medical issues pertaining to genital injuries, there are legal and psychological aspects of such events too which should not be ignored.

Genital Injuries: Are They Telling us Something about Sexual Violence?

Genital injury has a forensic relevance after a sexual assault and it has been discussed and investigated among professionals who work in this field. To analyze the studies published in the last decades, the present review examines different factors that may influence this finding, first clarifying terms of the forensic field, such as the peculiarity of the legal medical examination, and the distinction of the terms “legal” and “anatomical” vagina. Finally, it analyses if it is possible that the existence of these injuries in victims explain the lack of consent in sexual contact, and to clarify the meaning of the absence of injuries.

Patterns of Sexual Assault victims presenting to the University Teaching Hospital in Lusaka, Zambia: a Cross-Sectional Study

Background: Sexual assault, which encompasses defilement and rape, is a public health and public safety problem with the majority of victims being women and children. The consequences of sexual assault include physical injuries, psychological trauma, depression, suicide or suicide attempt and post-traumatic stress disorder (PTSD) as a long-term consequence. Others are unwanted pregnancies and risk of acquiring sexually transmitted infections including the Human Immunodeficiency Virus (HIV). There is little information about the conditions under which sexual assault occurs. The aim of this study was to determine the patterns of sexual assault victims presenting to the University Teaching Hospital (UTH). Materials and Methods: This was a cross-sectional study that was carried out on sexual assault victims who presented to UTH over a period of four months from December 2013 to April 2014. A total of 160 participants were recruited, 59 from the Gynaecology admission ward (C03) and 101 from the Paediatric Centre of Excellence Child Sexual Assault (PCOE-CSA). Participants were interviewed using an interviewer-administered questionnaire while some data was extracted from victims’ files including documented HIV status. Frequency tables were constructed and characteristics of sexual assault were compared between victims aged below 16 years and those aged 16 years and above. Data analysis was done using SPSS version 20. Results: The age of 160 victims ranged from 2 to 34 years and the most affected age group was 11-15 years (n=91; 56.9%). Victims were mostly single (n=149; 93.1%), had attained primary education or none (n=102; 63.8%) were unemployed (n=149; 93.1%) and resided in high-density areas (n=144; 90%). Only 7.5% (n=12) of victims tested HIV positive. A positive HIV test occurred 14 times more frequently in victims aged 16 years and above (OR = 14.32, CI = 2.35 – 87.22, P-value < 0.01). Majority of the incidents took place in residential homes (n=110; 68.8%) and these were significantly less common among victims aged 16 years and above (OR = 0.33, CI = 0.11 – 0.98, P-value = 0.05). The majority of perpetrators were known to the victims (n= 119; 74.4%). Sexual assault perpetrated by strangers affected victims aged 16 years and above more than those aged below 16 years (50.0% versus 17.5%; P <0.01). About half of victims (n=84; 52.5%) reported to UTH within 72 hours of assault and these were 4.5 times more likely to be aged 16 years and above (OR = 4.53, CI = 1.23 - 16.73, P-value = 0.02). Genital injuries were present in 70% of victims. The absence of genital injuries was 8 times more in victims aged 16 years and above (OR = 8.46, CI = 2.78 – 25.77, P-value <0.01). Conclusion: The majority of sexual assault victims were younger (<16 years). Younger victims were mostly assaulted by perpetrators known to them, mainly in residential homes while older victims were mostly assaulted by strangers in isolated places. Compared to older victims, younger victims presented more to UTH later than 72 hours the following the assault and sustained genital injuries more. Patters of sexual assault are therefore different in younger victims compared to adults.