Managing Reproduction Emergencies in the Field: Part 1: Injuries in Stallions; Injury of the External Portion of the Reproductive Tract and Gestational Conditions in the Mare.

Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and emergent conditions arising during gestation in mares. Conditions affecting male horses are discussed in the context of breeding stallions, but kicks or other mechanisms of trauma in the groin can also affect geldings. Priapism, paraphimosis, trauma to the scrotum and testicles, and penile injury are discussed. In mares, traumatic vestibular injury, placentitis, hydropsic conditions, prepubic tendon and abdominal wall compromise, and uterine torsion are included. Clinical recognition of the problem, diagnostic procedures, and treatments are summarized.

The association of bicycle-related genital numbness and Sexual Health Inventory for Men (SHIM) score: results from a large, multinational, cross-sectional study.

OBJECTIVE: To assess the association of genital numbness and erectile dysfunction in male cyclists. SUBJECTS AND METHODS: Cyclists were recruited through Facebook advertisements and outreach to sporting clubs. This is a secondary analysis of a larger epidemiological population-based study that examined sexual and urinary wellness in athletes. We queried cycling habits and erectile function using Sexual Health Inventory for Men (SHIM). RESULTS: A total of 2 774 male cyclists were included in the analysis. Amongst cyclists, there was a statistically significant increase in the trend of genital numbness presence with more years of cycling (P = 0.002), more frequent weekly cycling (P < 0.001), and longer cycling distance at each ride (P < 0.001). Less frequent use of padded shorts (odds ratio [OR] 0.14, P < 0.001) and lower handlebar (OR 0.49, P < 0.001) were associated with numbness, but body mass index (BMI) (OR 1.1, P = 0.33) and age (OR 1.2, P = 0.15) were not. In a multivariate logistic regression model, after adjusting for age, BMI, and lifetime miles (calculated by average daily cycling mileage × cycling days/week × cycling years.), there were no statistically significant differences in mean SHIM score between cyclists with and cyclists without numbness (20.3 vs 20.2, P = 0.83). However, interestingly, the subset of cyclists who reported numbness in the buttock reported statistically significantly worse SHIM scores (20.3 vs 18.4, P < 0.001). This association was not present in cyclists who reported numbness in the scrotum, penis, or perineum and remained significant after adjusting for overall biking intensity. CONCLUSION: Cyclists report genital numbness in proportion with biking intensity but numbness is not associated with worse sexual function in this cohort.

Treatment of Genital Burn Injuries: Traditional Procedures and New Techniques.

OBJECTIVE: Because genital burns are rare, only limited information on treatment guidelines is available in the literature. Vital tissue should be preserved to promote spontaneous healing because reconstruction does not always lead to satisfying results. The aim of this report is to present a general overview of current, prevailing treatment for genital burns and compare this to study authors' experiences. In addition, the article describes an entirely new approach of tissue-preserving bromelain-based enzymatic debridement of genital burn wounds. METHODS: This single-center study includes all patients who were treated for severe genital and perineal burn wounds at a burn intensive care unit between December 1995 and December 2016. A review of literature was performed in PubMed covering the years 1990 to 2016. RESULTS: A total of 149 patients were admitted with severe burns or scalding of the genitals or the perineum. As in the majority of cases reported in the current literature, most of these patients were treated conservatively. When there was demarcation of necrotic tissue, tangential excision and skin grafting were performed, and since 2015, 3 patients admitted to this facility have been treated with bromelain-based debridement followed by spontaneous healing. Certain small-scale studies in the literature describe a disproportionate number of surgical interventions. CONCLUSIONS: Based on this evidence, study authors support a conservative view of genital burn treatment. Enzymatic debridement allows earlier and more selective debridement, which can improve the aesthetic outcome.

Scrotal emergencies: An imaging perspective.

Acute scrotal pain is a common complaint in emergency or primary care practice. A myriad of pathologies need to be considered, and while the clinical history often leads the clinician to the correct diagnosis, radiologists are often called upon to provide further diagnostic information through ultrasonography. Here, we present the sonographic features of various scrotal emergencies, as well as a few pitfalls. Through this, we explore the breadth of urgent pathologies that may be encountered, both traumatic and non-traumatic. For the clinician who performs point-of-care ultrasound, whether in clinic or in the emergency department, we hope that this pictorial article will lay a good foundation for confident and accurate image interpretation.

Epidemiology of Genitourinary Injuries among Male U.S. Service Members Deployed to Iraq and Afghanistan: Early Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project.

PURPOSE: In this study we report the number, nature and severity of genitourinary injuries among male U.S. service members deployed to Operations Iraqi Freedom and Enduring Freedom. MATERIALS AND METHODS: This retrospective cross-sectional study of the Department of Defense Trauma Registry used ICD-9-CM codes to identify service members with genitourinary injuries, and used Abbreviated Injury Scale codes to determine injury severity, genitourinary organs injured and comorbid injuries. RESULTS: From October 2001 to August 2013, 1,367 male U.S. service members sustained 1 or more genitourinary injuries. The majority of injuries involved the external genitalia (1,000, 73.2%), including the scrotum (760, 55.6%), testes (451, 33.0%), penis (423, 31%) and/or urethra (125, 9.1%). Overall more than a third of service members with genitourinary injury sustained at least 1 severe genitourinary injury (502, 36.7%). Loss of 1 or both testes was documented in 146 men, including 129 (9.4%) unilateral orchiectomies and 17 (1.2%) bilateral orchiectomies. Common comorbid injuries included traumatic brain injury (549, 40.2%), pelvic fracture (341, 25.0%), colorectal injury (297, 21.7%) and lower extremity amputations (387, 28.7%). CONCLUSIONS: An unprecedented number of U.S. service members sustained genitourinary injury while deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Further study is needed to describe the long-term impact of genitourinary injury and determine the potential need for novel treatments to improve sexual, urinary and/or reproductive function among service members with severe genital injury.

Inguinoscrotal Pathology on Computed Tomography: An Alternative Perspective.

Computed tomography (CT) is not the imaging technique of choice to assess inguinoscrotal pathology, as magnetic resonance or ultrasonography have superior soft tissue contrast resolution and do not involve gonadal exposure to ionizing radiation. However, testicular and inguinoscrotal pathology may be found both as an extension of intra-abdominal processes or incidentally on CT scans requested for other reasons. CT also plays a role in the evaluation of testicular injury when associated to pelvic trauma and in perineal infections with scrotal extension. A pictorial review of testicular and inguinoscrotal involvement in vascular, neoplastic, traumatic, infectious, or inflammatory diseases and in complications of abdominal surgeries is presented. Additionally, the CT appearance of several congenital anomalies and benign processes is depicted.

The influence of sexual orientation and sexual role on male grooming-related injuries and infections.

AIM: Pubic hair grooming is a common practice in the United States and coincides with prevalence of grooming-related injuries. Men who have sex with men (MSM) groom more frequently than men who have sex with women (MSW). We aim to characterize the influence of sexual orientation and sexual role on grooming behavior, injuries, and infections in men in the United States. METHODS: We conducted a nationally representative survey of noninstitutionalized adults aged 18-65 residing in the United States. We examined the prevalence and risk factors of injuries and infections that occur as a result of personal grooming. RESULTS: Of the 4,062 men who completed the survey, 3,176 (78.2%) report having sex with only women (MSW), 198 (4.9%) report sex with men (MSM), and 688 (16.9%) report not being sexually active. MSM are more likely to groom (42.5% vs. 29.0%, P < 0.001) and groom more around the anus, scrotum, and penile shaft compared with MSW. MSM receptive partners groom more often (50.9% vs. 26.9%, P = 0.005) and groom more for sex (85.3% vs. 51.9%, P < 0.001) compared with MSM insertive partners. MSM report more injuries to the anus (7.0% vs. 1.0%, P < 0.001), more grooming-related infections (7.0% vs. 1.0%, P < 0.001) and abscesses (8.8% vs. 2.5%, P = 0.010), as well as lifetime sexually transmitted infections (STIs) (1.65 vs. 1.45, P = 0.038) compared with MSW. More receptive partners report grooming at the time of their STI infection (52.2% vs. 14.3%, P < 0.001) compared with insertive partners. CONCLUSIONS: Sexual orientation, and in particular sexual role, may influence male grooming behavior and impact grooming-related injuries and infections. Anogenital grooming may put one at risk for an STI. Healthcare providers should be aware of different grooming practices in order to better educate safe depilatory practices (i.e., the use of electric razors for anogenital grooming) in patients of all sexual orientations.

Pubic hair preferences, reasons for removal, and associated genital symptoms: comparisons between men and women.

INTRODUCTION: Pubic hair grooming and removal are common behaviors among men and women. However, little is known about the reasons for grooming, preferred pubic hairstyle of sexual partners, and symptoms associated with regular grooming. AIMS: This study aims to assess pubic hair removal/grooming practices, pubic hairstyle preferences, and genital outcomes associated with pubic hair removal among men and women in a college sample. METHODS: Data were gathered from 1,110 participants (671 women and 439 men) at a large public Midwestern university and a small Southern public university. MAIN OUTCOME MEASURES: Items assessed demographics, pubic hair grooming and removal practices in the past 4 weeks, reasons for pubic hair status, preference for pubic hairstyle of sexual partners, and symptoms associated with removal and grooming. RESULTS: Most (95%) participants had removed their pubic hair on at least one occasion in the past 4 weeks with shaving being the most commonly reported hair removal technique by women (82%) and men (49%). Women were significantly more likely to report their typical status as hair-free (50% vs. 19%; χ(2) = 165.528, P < 0.001) and men were significantly more likely to prefer a hair-free sexual partner (60% vs. 24%; χ(2) = 211.712, P < 0.001). Genital itching was experienced on at least one occasion by 80.3% of pubic hair groomers and was the most commonly reported side effect. CONCLUSION: Genital grooming and pubic hair removal are common practices among both men and women of college-age. Women are likely to report stronger associations with feelings of cleanliness, comfort, sex appeal, social norms of their peer group, and affordability as reasons for their chosen pubic hair style. Women also report more experiences with genital side effects of pubic hair removal, an expected result as women are removing pubic hair more frequently and more completely than their male counterparts.

Lower male genitourinary trauma: a pictorial review.

Blunt and penetrating trauma to the male pelvis and external genitalia may result in significant injury to the lower genitourinary system including the bladder, urethra, penis, and scrotum. Emergent imaging plays an important role in identifying these injuries and directing appropriate, timely management. In this article, we review indications for dedicated genitourinary system imaging in trauma and illustrate the imaging features of injuries to the lower male genitourinary system in order to facilitate accurate and rapid diagnosis.

Preoperative hair removal on the male genitalia: clippers vs. razors.

INTRODUCTION: In an effort to reduce the incidence of postoperative surgical site infections (SSIs), many hospitals have adopted a strict practice of preoperative hair removal using clippers, as opposed to razors. However, the skin of the male genitalia is delicate, elastic with irregular skin folds and may be ill-suited for clippers. AIM: To compare shave quality and the degree of skin trauma using two methods of preoperative hair removal on the scrotal skin: clippers vs. razors. METHODS: Patients undergoing surgery involving the male genitalia requiring preoperative hair removal were randomized to hair removal using clippers or a razor. Immediately following hair removal, a standardized digital photograph was taken of the male genitalia. All digital photos were evaluated in a blinded fashion by groups of urologic surgeons and surgical nurses using a standardized five-point global rating scale. The incidence of SSIs was monitored. MAIN OUTCOME MEASURES: Primary outcomes included blinded global ratings of (i) the completeness of the preoperative hair removal within the surgical field and (ii) degree of skin trauma following hair removal. The incidence of SSIs within 3 months of surgery was monitored throughout the study period. RESULTS: Two hundred fifteen consecutive patients were randomized (107 clipper, 108 razor). Overall, preoperative hair removal on the male genitalia using a razor resulted in significantly less skin trauma (P = 2.5E-10) and a more complete hair removal within the surgical field (P = 0.017) compared with clippers. SSIs were identified in four patients during follow-up (1.8%--two using clippers; two, razors). CONCLUSIONS: Our data suggest that preoperative hair removal on the scrotal skin using a razor results in less skin trauma and improved overall shave quality with no apparent increased risk of SSIs. Based on these findings, surgeons should be permitted their choice of razors or clippers for preoperative preparation of the male genitalia.

The development and introduction of ballistic protection of the external genitalia and perineum.

In response to an Urgent Operational Requirement, the UK Ministry of Defence (MoD) investigated, designed, developed, trialled and subsequently fielded a Tiered Pelvic Protection System to service personnel deployed on Operation HERRICK in Afghanistan. An Urgent Statement of User Requirement (USUR) was drafted in order to equip service personnel with protection for the groin, perineum, buttocks and upper thigh areas from the effects of buried Improvised Explosive Devices (IEDs). Injuries to the groin and pelvic area from buried IEDs can have severe physiological and psychological impact; therefore the aim of the pelvic protection was to reduce the number and severity of such injuries and to improve the outcome, both in terms of quality of life of the survivors and increase the chances of survival. The aim of this paper is to outline some of the research and development that contributed to the design(s) of the Tiered Pelvic Protection System; describe the components of, and report the medical success of, the Tiered Pelvic Protection System.

Immediate surgical management of combat-related injury to the external genitalia.

Patterns of survivable injury after combat injury have changed during recent years as wounding mechanisms have altered, ballistic protection has improved and the military chain of trauma care has evolved. Combat casualties now survive injuries that would have been fatal in previous wars and service personnel can be left with injuries that have significantly detrimental effects on their quality of life. Severe, destructive injuries to the external genitalia are rarely life-threatening, but can be profoundly life altering and the immediate management of these injuries deserves special scrutiny. The general principles of haemorrhage control, wound debridement, urinary diversion, and organ preservation should be observed. An up-to-date review of the management of these relative rare injuries is based on recent, albeit scanty literature and the experiences of managing casualties in the medical evacuation chain of the United Kingdom Defence Medical Services. The rationale behind the current emphasis on post-injury fertility preservation is also discussed.

Managing endocrine dysfunction following blast injury to the male external genitalia.

Blast injury to the external genitalia is associated with considerable morbidity, including the risk of primary hypogonadism due to insufficient testosterone. It is of the utmost importance that, prior to any testosterone replacement being commenced, serious consideration is given to sperm retrieval. The clinical and biochemical picture of hypogonadism allows a relatively straightforward diagnosis in most cases although it is important to be alert to the possibility of hypogonadism in the context of partial testicular tissue preservation. It is also prudent to consider the possibility of secondary hypogonadism especially in patients with chronic pain or those on opiate medication. Therapeutic options for testosterone replacement are diverse but relatively simple. This article aims to give guidance to the non-specialist in the consideration, diagnosis, and treatment of hypogonadism, with particular reference to blast injury of the external genitalia.

The psychological challenge of genital injury.

INTRODUCTION: Injuries sustained from Improvised Explosive Devices (IEDs) can have a devastating impact on bodily integrity; physical injuries can be severe and include traumatic amputation of limbs, pelvic fracture, abdominal trauma, extremity fragmentation wounds and genital trauma. Soldiers suffering from genital trauma can experience overwhelming emotions and adjusting to their injuries is a process that occurs over time, that some find easier than others. This paper explores current practice and identifies guidelines for psychological interventions within this arena. METHODS: Relevant associated literature has been reviewed to identify the long-term consequences of genital trauma and to ascertain best practice in supporting this patient population. Current practices within the Royal Centre for Defence Medicine (RCDM) and the Defence Medical Rehabilitation Centre (DMRC) Headley Court have been explored. RESULTS: There is little published literature in this area. Therefore, in respect of guiding treatment of this patient population, related research on the psychological consequences of prostate and penile cancer, limb amputation, acquired infertility and acquired disability has been used as a base to inform interventions. Current practices at RCDM and DMRC have been found to support interventions within related areas. CONCLUSIONS: There is no published evidence base to guide psychological interventions for genital trauma. Professional multidisciplinary intervention will potentially be beneficial in establishing the long-term needs of this patient population, together with qualitative research exploring the experience of soldiers suffering genital trauma.

Emasculation: gloves-off strategy enhances eunuch spider endurance.

Males of sexually cannibalistic spiders commonly mutilate parts of their paired genitals (palps) during copulation, which may result in complete emasculation or the 'eunuch phenomenon'. In an orb-web nephilid spider, Nephilengys malabarensis, about 75 per cent of males fall victim to sexual cannibalism, and the surviving males become half-eunuchs (one palp emasculated) or full-eunuchs (both palps emasculated). While it has been shown that surviving eunuchs are better fighters compared with intact males when guarding the females with which they have mated, mechanisms behind eunuchs' superior fighting abilities are unknown. The previously proposed 'gloves-off' hypothesis, attributing eunuchs' enhanced locomotor endurance to the reduction in total body weight caused by genital mutilation, is plausible but has remained untested. Here, we tested the gloves-off hypothesis in N. malabarensis by comparing the time until exhaustion (i.e. endurance) of intact males with half- and full-eunuchs created experimentally. We found that by reducing body weight up to 4 per cent in half-eunuchs and 9 per cent in full-eunuchs through emasculation, endurance increases significantly in half-eunuchs (32%) and particularly strongly in full-eunuchs (80%). Our results corroborate the gloves-off hypothesis and further point towards the adaptive significance of male emasculation.

Physical evidence of child sexual abuse.

UNLABELLED: Child sexual abuse is increasingly recognised in all societies, affecting boys and girls alike in all age groups and often involving oral, anal and vaginal penetration. The presence of physical evidence following suspected child sexual abuse is important in confirming the diagnosis and providing legal corroboration that abuse has occurred. Whilst many children have no physical evidence, its presence should be carefully sought and documented by skilled examination, regardless of the time interval between any suspected abuse and the examination. When examination is close to the time of the abuse, forensic sampling may be required. Although many children have no physical findings, understanding the significance of physical findings has increased with both experience and research, although certainty and agreement is lacking in some areas. There are few case control studies of abused and non-abused children where standard terminology, examination method and description allow for meaningful comparison. CONCLUSIONS: Physical findings rarely provide conclusive evidence of sexual abuse in isolation but may offer important pieces of the diagnostic "jigsaw picture".

Fertility preservation in the male: from childhood to adulthood.

Approximately 50% of males will develop cancer during their lifetime. In the past, oncologic therapies have largely been focused primarily on cure of the underlying malignancy. With improvements in both diagnostic modalities and treatments, pediatric and adult cancer patients are routinely surviving their disease. For this large group of patients, survivorship issues have become a major concern. Central among these survivorship issues is fertility. For males diagnosed with a malignancy, impaired reproductive potential is often noted even before any cancer therapy has been initiated. Furthermore, cancer treatments, in the form of chemotherapy, radiation therapy, and surgery, can all have potentially deleterious and lasting effects on male reproductive capability. For these reasons, a change in oncologic treatment paradigms has occurred. Now, the offer of fertility preservation to males diagnosed with cancer is a key component of comprehensive oncologic care.

Servicemembers' Group Life Insurance Traumatic Injury Protection Program--genitourinary losses. Final rule.

The Department of Veterans Affairs (VA) is issuing this final rule that amends the regulations governing the Servicemembers' Group Life Insurance Traumatic Injury Protection (TSGLI) program by adding certain genitourinary (GU) system losses to the TSGLI Schedule of Losses and defining terms relevant to these new losses. This amendment is necessary to make qualifying GU losses a basis for paying TSGLI benefits to servicemembers with severe GU injuries. The intended effect is to expand the list of losses for which TSGLI payments can be made. This document adopts as a final rule, without change, the interim final rule published in the Federal Register on December 2, 2011.

Risk factors for genital lichen sclerosus in men.

BACKGROUND: Lichen sclerosus (LS) is an inflammatory disease of the skin and mucous membranes. Its aetiology is still unknown. OBJECTIVES: To determine risk factors for genital LS in men. METHODS: In a case-control study, 73 patients with LS, consecutively diagnosed at the City Dispensary for Skin and Venereal Diseases in Belgrade, were compared with 219 male patients visiting the same institution because of tinea cruris. Univariate and multivariate logistic regression analyses were used for analysis of data collected. RESULTS: According to multivariate logistic regression analysis, risk factors for male LS were as follows: a personal history of genital injury [odds ratio (OR) 28·1, 95% confidence interval (CI) 5·2-150·8], vitiligo (OR 23·1, 95% CI 2·2-240·2), alopecia areata (OR 8·8, 95% CI 1·1-68·5) and hypercholesterolaemia (OR 3·1, 95% CI 1·1-8·2), and a family history of alopecia areata (OR 24·3, 95% CI 2·1-280·7), diseases of the thyroid gland (OR 9·1, 95% CI 2·3-36·2) and other autoimmune diseases (OR 8·6, 95% CI 1·3-58·6). CONCLUSIONS: The results of the present study are in line with the hypothesis that trauma of the penis is a possible trigger of symptoms in genetically predisposed individuals and that personal and family histories of autoimmune disorders are risk factors for male LS.

Management of urogenital trauma: state of the art.

PURPOSE OF REVIEW: The field of urogenital trauma is undergoing constant improvement mainly due to better diagnostic tools, a shift toward standardized treatments and better trauma care. The purpose of this review is to summarize the most relevant studies published within the last 3 years on the subject. RECENT FINDINGS: Computerized tomography grading of renal trauma is an excellent predictor of the need for surgery and the final renal outcome in these patients, as most patients can be treated conservatively. Computerized tomography cystography has become the standard for the diagnosis of bladder rupture in which the indications for surgical intervention may be changing. The most common urethral trauma is posterior urethral injury due to pelvic fracture. The best results in adults and children are achieved by urethroplasty. SUMMARY: The diagnosis and treatment of genitourinary trauma is still evolving. The long-term sequels of these injuries may best be treated by urologists expert in urogenital reconstruction. In the future, tissue engineering may have an important place in the treatment of these patients.