Management of Post-Coital Genital Trauma

Clinical Assessment and Diagnosis

The American Urological Association suggests that the constellation of swelling, dysuria, light bleeding, and urinary hesitancy two days post-trauma suggests either anterior urethral/vaginal mucosal injury or urinary tract infection, with the former being more likely given the mechanism and timing 1, 2
The presence of blood at the urethral meatus or vaginal vault is a key physical examination finding, present in 37-93% of urethral injuries, and should be specifically assessed 1, 2
Perineal/genital ecchymosis indicates tissue trauma severity, and labial edema is a cardinal sign in females with urethral injuries 1, 2, 2
The ability to void is an important assessment, as complete inability suggests more severe injury requiring immediate intervention 1, 2

Urinalysis with culture is essential to rule out concurrent UTI and assess for hematuria, which is present in 77-100% of bladder/urethral injuries 2
Retrograde urethrography is recommended if urethral injury is suspected based on blood at meatus, inability to void, or severe dysuria 1, 2
STI screening is necessary, given sexual exposure, and should include testing for N. gonorrhoeae and C. trachomatis via nucleic acid amplification test 3, 4

The primary management of traumatic injury without urethral disruption includes urinary catheter drainage for 7-14 days, analgesics, pelvic rest, and sitz baths 1, 2, 4
Monitoring should include re-evaluation in 3 days, with failure to improve requiring reassessment for missed injury or infection 4
If STI testing is positive, treatment should include ceftriaxone and doxycycline, and sex partners should be treated within 60 days of symptom onset 3, 4

Follow-up requirements include 3-day reassessment, post-catheter removal evaluation, and long-term monitoring for delayed stricture formation 1, 2, 4
The management principles for FTM patients who have not undergone genital reconstruction surgery are identical to those for female patients, with the same anatomical structures at risk for the same injury patterns from the same mechanisms 1, 2