Vaginal injury resulting from blunt trauma: still an under evaluated entity

Vaginal lacerations (VL) caused by blunt trauma are often underreported despite their potential for serious physical and psychological consequences. While vaginal injuries from childbirth, consensual intercourse, and sexual violence are well-documented, those resulting from blunt trauma mechanisms are less frequently studied. Their true incidence remains unclear due to inconsistent reporting and lack of routine gynecological assessment. This study aimed to assess the incidence of blunt VL, the presence of associated injuries and compare differences between pediatric and adult populations.

This retrospective study utilized data from the National Inpatient Sample (NIS) to identify patients with a confirmed diagnosis of VL between 2016 and 2019. The analysis included 1600 cases, categorized into two groups: pediatric (Group A, aged <18) and adult (Group B, aged ≥18). Data on demographics, length of hospitalization, associated injuries, and mortality rates were collected. Comparative analyses between the groups focused on injury patterns and clinical outcomes. Statistical significance was assessed using independent sample t-test, Pearson's chi-square test, and multivariate logistic regression.

Among the 1600 cases, 1195 (74.7 %) were adults. 995 (62.2 %) of them had pelvic fractures, mostly involving the sacrum and lumbar vertebrae. Pediatric patients showed a higher incidence of abdominal injuries. Multivariate analysis revealed that injuries to the ilium, acetabulum, lumbar vertebrae, small intestine, and colon were significantly associated with the occurrence of blunt VL. There were no significant differences in length of stay rates between the groups.

Blunt VL are commonly associated with extra-vaginal injuries, particularly with pelvic fractures. These findings contribute to a better understanding of the patterns of injuries, associated with blunt VL and highlight the need to better define the role of routine vaginal examination during trauma management. Future prospective studies are needed to validate these findings and refine trauma care guidelines.