- Today we're discussing seven accidental vaginal injuries
you've never considered could happen
and will now never forget.
Welcome back, I'm Mama Doctor Jones,
a board certified OB-GYN and mom to four.
And if you're anything like me,
you will find this video
equal parts fascinating and terrifying.
Although there's no graphic imagery in this video,
some people may find the content that we're discussing
a little bit disturbing.
If you need to click away and come back for the next video,
I totally understand,
but maybe consider not doing any water sports
while you're gone.
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We talk about all things, periods, pregnancy, vaginas,
and everything in between.
I promise you will leave
with interesting things to tell your friends.
In medicine, we have something called a case report.
This is basically where a physician
or other member of the healthcare team
who is taking care of someone with a rare illness or injury
writes up a publication about the injury
and how they managed it
in order to improve access
to that information in the future.
So if somebody comes into my hospital
with a very rare condition
or something that I haven't personally taken care of,
I can look up the case reports,
see how other physicians have managed it
and decide what to do in our situation.
Today's video is just a collection of case reports.
Some of the wildest vaginal injuries that I've read about,
how they occurred, how they were treated,
and how the patients did afterwards.
Jet skis, sometimes called personal watercraft,
are a relatively common way to get injured.
Although most of the time,
these injuries are things like cuts, bruises,
maybe concussions, and broken bones,
sometimes they are way worse.
If you're unfamiliar with jet skis,
they basically have a jet propulsion of water
that comes out of the back.
So what can happen if you're straddled on a jet ski
and get thrown off the back at high speeds
in a seated position
is that that air and water can be forced into the vagina
and rectum at high speeds causing massive injuries.
Our first case report is a story of a 26-year old female
who was a backseat passenger on a jet ski
and had exactly that happen to her.
She was thrown off at high speed in a seated position,
and immediately noticed pain and bleeding from the vagina.
She was taken to the emergency room,
stabilized and evaluated there.
After initial stabilization,
she was taken to the operating room
for something called an EUA or exam under anesthesia.
This is basically where the patient is put to sleep
so that the care team can better evaluate their injuries
without them being uncomfortable or in severe pain.
She also had something called an anoscopy,
which is where a camera is introduced through the anus
to look at the inside of the rectum
and make sure there are no internal injuries to the bowel.
During these exams,
it was found that she had several very big injuries
to the inside of the rectum and vagina,
including one injury
that went all the way through the rectum
and to the vagina, connecting them.
One of the vaginal injuries
had very profuse arterial bleeding,
which is really not uncommon with vaginal injuries.
The vagina is an extremely well-vascularized place,
and so it has a tendency to bleed profusely
if any injuries occur.
Given the severity of the injuries to her rectum,
it was decided that they needed to do something
called a diverting colostomy,
where they make a big incision on the belly
and they divert fecal matter through a bag on the outside
to allow the lower GI tract time to heal
after they repair the injuries.
Quite understandably,
she suffered from some PTSD and depression
in the days and weeks after her injury,
and she was treated for that.
But she did get to go home on post-op day five
and she did well.
She was seen back a couple of months after her injuries
and seemed to be doing well.
And then 12 weeks after the initial injuries,
she had her colostomy reversed
so that she could get back to normal function.
The second case is a really similar case
of a 29-year old who was the passenger on a jet ski.
She was thrown off the back in exactly the same manner.
Fortunately for her,
she didn't have any injuries to her rectum.
Unfortunately, her vaginal injury was very severe.
It went through the posterior or back part of the vagina,
all the way through the vagina,
behind the cervix, and into the abdomen.
Obviously, this can be very dangerous
because when you have an opening
from the vagina to the abdomen,
it's essentially an opening into your abdomen
from the outside world.
And normal vaginal flora or bacteria
that gets into the abdomen
can make you very, very sick, very quickly.
This is called peritonitis,
and it can be life-threatening,
She's really, really lucky that her medical team
recognized that that was there
so that they could fix it before that happened.
So the moral of these two stories
is that jet skis can be dangerous
for your vagina and rectum.
Obviously these are two rare events.
That's why they're written up in case reports.
Please be careful out there if you decide to use a jet ski,
they can also be dangerous in other ways.
Mo make sure you're taking precautions to stay safe.
The next case is actually a three-year-old
who came into the emergency room with vaginal bleeding.
If you're a gynecologist or an ER doctor,
whoever takes care of pediatric patients,
you know that when you have a child with vaginal bleeding,
there are two things that immediately come to mind.
The first of those is, is this child being sexually abused?
Luckily, that was not the cause of this case.
The second is, has this child put something
somewhere it doesn't belong?
Kids are notorious for putting things
into their random body orifices.
In fact, yours truly, once put an M&M up her nose
so far that nobody can see it,
and my mom didn't even know it was there
until she noticed I had very colorful snot
coming out of my nose.
Given that the vagina is a body orifice,
it is not uncommon for children to stick things in there
just to see where it goes.
So this little girl's exam,
when she got to the emergency room was relatively normal.
An ultrasound of her bladder and abdomen
didn't give them any answers.
However, when they did a pelvic x-ray,
they noticed something on the imaging that looked like this.
So this little circle you see
in the bottom part of this image
is not supposed to be there.
It's not part of her normal anatomy.
It looks to represent something inside the vagina.
Anytime you have a child
with a suspected foreign body in the vagina,
or any time a child needs a vaginal exam,
you are always going to do this under sedation.
There is no reason a child should have a vaginal exam
without being asleep.
It is extremely traumatic and it can be very painful.
So that's what they did.
They took the patient to the operating room
and put her to sleep.
They did an exam under anesthesia,
like the cases we've talked about before,
and they also did something called a vaginoscopy,
where they looked inside the vagina with a camera.
When they did that,
they found a small metal object
embedded into the vaginal tissue.
And it was surrounded by severe vaginal burns
and necrotic, or dying tissue.
They were able to remove
what ended up being a one centimeter button battery
from her vagina,
and she stayed in the hospital for a couple of days,
but went home and did very well.
This is something almost all gynecologists have seen,
not the button battery part,
but foreign objects in the vagina of a child,
because they just do that.
They just put things up there.
And they're not usually worthy of a case report.
This one is particularly interesting
because button batteries are extremely caustic.
These are the batteries that are in things like watches
and car key fobs,
sometimes in little toys,
or greeting cards that sing, things like that.
And they contain hydroxide ions,
which are extremely caustic.
Think like drain cleaner,
that level of caustic necrosis on the tissue.
It causes something called liquefactive necrosis,
which essentially causes the tissue that it exposes
to melt away and die.
If swallowed, button batteries can be severely dangerous
and life-threatening because they can eat through the bowel
and they can do it very, very quickly.
This is a very common way for kids to be injured.
So please, if you have anything
that contains button batteries in it,
keep them put up away from your children.
The next case is a story of an eight year old girl
who fell while inline skating with her sister and cousin.
During the fall, her legs abducted or moved apart,
kind of in a split-like fashion.
And she immediately noticed significant pain and bleeding.
When she was taken to the ER,
it was noted that she had a very big perineal
and vulvar laceration,
as well as a vulvar and vaginal hematoma.
A hematoma is where a collection of clotted blood
stays inside the body tissue because it can't get out
and it can cause a lot of pain.
It has to be surgically evacuated or removed in some cases.
And that's exactly what they did here,
as well as repairing the laceration.
She stayed in the hospital a couple of days,
but ended up doing very well
and not having any long-term complications from this.
This is called a straddle injury.
Although most of the time when it happens,
it happens on things like balance beams or bicycles,
but it can happen even just
from sudden splitting of the legs.
As with all cases of pediatric trauma
to the vulva and perineum,
you always wanna rule out sexual abuse.
Luckily, this was a witnessed injury
with several people around.
So there's no suspicion of that in this case.
Our next case is a story of a three-year-old girl
who was an unrestrained passenger in a car accident.
This little girl was in the backseat, not buckled in,
when the car she was riding in collided with another.
She was thrown from the car.
And when they came to find her, luckily, she was alive,
but she had a very unstable pelvis,
meaning probably she had severe pelvic fractures.
She was taken to the operating room
where she required extensive surgery
to repair both her bony pelvis,
the arterial supply to her legs,
as well as significant injuries to her GI tract,
as well as vagina.
Her injuries are probably due to rapid
and quick movement of the pelvis
and breaking of those bones.
But they are very similar
to what we discussed in the first case.
And she also ended up with a colostomy
to divert her fecal matter
so that her lower GI tract and vagina could heal.
The vaginal injury that she had started at the perineum
and went all the way up the vagina to the cervix.
And it was repaired in the operating room.
Obviously, she was asleep during that repair.
She had to have an external pelvic fixator
put on her bony pelvis,
so she couldn't move at all
or bear any weight for several weeks after the surgery.
I have an almost three-year-old at home
and I can not imagine him having to stay still
and not be able to weight bear or walk around
for eight weeks.
Please buckle your kids in.
Always, always, always put them in a car seat.
It doesn't matter if you're going around the block
or to another state,
they need to be restrained in the vehicle.
She is very lucky to be alive,
and she had a very skilled surgical team
to make sure that she didn't have
any long-term issues from this,
but it could have easily gone another way.
Our next story is the story of a 29-year old female
who was at a water park and went down a water slide.
I think we're probably noticing a theme here
that water sports are a little bit dangerous
for people who have a vagina.
She presented to the emergency room
with profuse vaginal bleeding and severe abdominal pain,
but she didn't note any significant injuries.
She said, I just went down the water slide,
and all of a sudden I noticed
that my vulva was hurting really bad.
When I stood up, I had bleeding
and my abdomen was hurting as well.
She was taken to the operating room
for an exam under anesthesia.
And when they did the pelvic exam using a speculum,
what they saw was a loop of intestines.
Yes, you heard that right.
She had a vaginal laceration
that was so severe and so significant
that her intestines were actually coming out of the abdomen
through the vagina.
Anytime this happens,
you have to make a big midline incision on the belly
to look at the bowel and make sure it is all healthy.
Bowel that's exposed to the outside world
can get very sick very quickly.
Sometimes that means we have to remove
a section of the bowel and reconnect it
because the dead tissue
that was exposed to the outside world
is never going to recover.
Luckily for her,
she had gone to the ER very quickly
and gotten help really soon.
So her bowel was still healthy
and they didn't have to remove any of it.
After it was confirmed that her bowel is still healthy,
they repaired the laceration from the inside,
closed her abdomen,
and then repaired the vaginal portion as well.
She did very well postoperatively
and didn't have any long-term complications from that.
I'm terribly sorry if I ruin water slides for you
because personally,
I don't think I'm ever going down a water slide
without thinking of this case report
called vaginal evisceration from a waterslide ever again.
The next case is a 44-year old female
who is enjoying a day on the lake,
water skiing with her friends.
I'm sure you can already tell where this is going.
She fell and immediately noticed vaginal bleeding and pain.
She presented to the ER and had an evaluation there,
and was noted to have a six centimeter vaginal laceration.
Lucky for her, this was the extent of her injuries.
But I did want to highlight this case as well,
because I think it points out
that water injuries can be really, really severe.
In reality, these cases are really rare.
That's why they have case reports written about them.
However, most of us, as gynecologists,
have seen some sort of water-related vaginal injury
at some point in our career.
So I wanted to talk about it
because I think it's not something
that most people know about.
I don't know that there's a way
that you can completely prevent it.
If you're partaking in any kind of sport,
you're at risk for injury.
If you decide to go water skiing or jet skiing,
it is probably worth wearing some kind of swimsuit
that is not like a traditional cut.
Get something like shorts to put over your swimsuit
that are tight-fitting
and maybe protect the vulva a little bit better.
You'll see if you look at professional water skiers
that they're not wearing bikinis when they water ski.
And that is one of the reasons
because you need to protect your vulva
just a little bit more in the case of a fall.
Our last story is a 62-year old woman
who decided to give vaginal steaming a try.
Although there's no medical benefit to vaginal steaming,
it is something that is commonly practiced
in certain cultures.
However, it recently gained modern
and non-cultural significance
thanks to goop and Gwyneth Paltrow
making wild claims about its health benefits.
I want to, again, state,
there are no medical benefits to vaginal steaming,
but it can be a commonly-used cultural practice.
So this patient is a 62-year old Chinese woman
who has stage four vaginal prolapse.
Vaginal prolapse is where the pelvic floor muscles
have relaxed to the point
that the cervix and uterus have fallen.
And sometimes even to the point
that the cervix is actually exiting the vagina.
That's where we call it stage four.
And that's what she has.
She'd been a bit hesitant
about having surgical management
and had tried something called a pessary
to help fix the vaginal prolapse.
Unfortunately with prolapse this severe,
that's rarely going to work.
And that was the case for her.
She decided that she would go ahead
and move forward with the surgical repair,
which is really the only thing you can do
when vaginal prolapse gets that severe.
However, she was still a little bit nervous about it.
At the urging of her traditional Chinese doctor,
she was told to try vaginal steaming,
as he indicated that it might help
with her vaginal prolapse.
There's really no way that this could actually help
because prolapse is a structural issue
and steam and herbs is not going to fix that.
However, most of the time, it's not harmful.
Unfortunately, in this case, it was.
He instructed her to boil a pot of water
with an herbal mixture,
put it on the inside rim of the toilet, and sit over it.
Over the next few days,
she followed his instructions
and did this a couple of times.
However, in the days following,
she noticed she had new and significant vaginal discharge.
She presented to the ER denying pain,
but with this complaint of vaginal discharge.
And on exam, it was noted that her cervix and vagina
had severe second degree burns all over them.
And that is what was causing the vaginal discharge.
Luckily, this was able to be treated with burn creams.
And after she healed,
she was still able to proceed with the surgery
to fix her prolapse.
Although I'd never tell someone not to do vaginal steaming
if it is something that is ingrained in their culture,
I do think it's important to know
that although most of the time it is not dangerous,
it can be.
Likely the reason
that it was more dangerous for this patient
is because of the prolapse.
Her cervix was situated much closer
to the pot of boiling water
than the average person would have.
I do want to reiterate
that there is no medical benefit
and most of the U.S. companies selling products
that go along with vaginal steaming
are appropriating this culture to make money off of you.
If it's not a part of your culture,
I would just strongly recommend staying away from it.
And if this is something that's a part of your culture,
please make sure you find a trusted source
to help you do it safely
and make sure to mind your vulva
and perineum in the process.
That's enough terrifying stories
of vaginal injuries for today.
If you missed my last episode
of OB-GYN reacts to I didn't know I was pregnant,
it is my favorite episode ever.
I'm gonna put it right over here
and you should really go watch it.
It's so good.
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And I will see you next Monday.