Although obstetric injuries remain the most common cause of traumatic damage to the female genital

tract, nonobstetric injuries are becoming a frequent gynecologic emergency. This type of injury usually
occurs as a consequence of rape and other forms of sexual violence [1,2]. It has been reported that
nonobstetric genital injuries could represent as many as 1/1,000 gynecologic emergencies [1–3].

Trauma obstetrik tetap menjadi penyebab paling umum kerusakan traumatis pada traktus genitalia
wanita, cedera nonobstrik menjadi keadaan darurat ginekologi yang sering terjadi. Cedera jenis ini
biasanya terjadi sebagai akibat dari perkosaan dan bentuk-bentuk kekerasan seksual lainnya [1,2]. Telah
dilaporkan bahwa cedera genital nonobstetric dapat mewakili sebanyak 1 / 1.000 keadaan darurat
ginekologis [1-3].4

The contribution of coitus to nonobstetric traumatic lesions of the female genital tract has been estimated
to be around 32% [4]. Most female genital tract injuries consecutive to coitus are minor injuries following
“normal” sexual inter course, frequently during the first sexual experience in the female patient [5].

Kontribusi koitus terhadap lesi traumatik nonobstetrik pada traktus genitalia wanita diperkirakan sekitar
32% [4]. 4

However, coitus sometimes results in more extensive lacerations of the female genital tract causing
profuse life-threatening vaginal bleeding and requiring immediate intervention [7]. It has been reported
that nonconsensual intercourse results more often in severe injuries [6,8,9].

Namun, koitus kadang-kadang menghasilkan laserasi yang lebih luas dari traktus genitalia wanita, dapat
menyebabkan perdarahan vagina yang mengancam jiwa dan membutuhkan intervensi segera [7]. Telah
dilaporkan bahwa hasil hubungan nonconsensual seperti pemerkosaan lebih sering menyebabkan cedera
berat [6,8,9]. 4

Factors such as male to female “disproportion,” chronic vaginal infection, position during coitus, long
period of sexual abstinence, and the use of aphrodisiacs have been reported to increase the risk of
occurrence of sexual injury during coitus [2,10,11].

Faktor-faktor seperti disproporsi ukuran pria-wanita, infeksi vagina kronis, posisi selama koitus,
periode pantangan seksual yang lama, dan penggunaan afrodisiak (zat kimia yang digunakan
untuk merangsang daya seksual) telah dilaporkan meningkatkan risiko terjadinya cedera seksual
selama koitus [2,10,11]3

Penanganan kasus cedera nonobstetrik bersifat multidisiplin tergantung pada luas

cedera,kehilangan darah dan komplikasi. Komplikasi utama dari cedera koitus adalah
perdarahan, stenosis vagina, sepsis, perlukaan pada organ abdominopelvis, fistula
rectovaginal, dan kematian.3

Kondisi ini dapat dicegah oleh pendidikan seks untuk semua dan membatasi kebiasaan
perkosaan yang tidak dapat diterima di masyarakat.3

The rich vascular supply to the vulva places it at risk for bleeding from trauma. Vulval haematomas are
the most common sequelae. In adult women, the labia majora are comprised of large fat pads, which act
to protect the vulva against injury. In contrast, children lack welldeveloped fat pads in this area and often
engage in play activities predisposing them to vulval trauma; thus, they are more likely to sustain vulval
injuries than adults eg “Straddle injuries”10

Any female with a complaint of vulvovaginal pain, bleeding or swelling should undergo a careful
examination to look for vulval or vaginal trauma or laceration. Patients may not be forthcoming with
details of the events that caused the trauma. Therefore, identifying those at risk is a crucial step in
management. The possibility of sexual abuse or assault must always be considered.10

A straddle injury is when trauma occurs to the groin area between the thighs. It can happen from straddling
a hard object, or accidents such as falling onto a bicycle crossbar.
The injury can cause damage to the outer genitals. In women, this is the vulva. It includes the outer and
inner labia and the clitoris. In men, this includes the scrotum, testes, and penis. The groin area will likely
be bruised, bleeding, and painful. The injury can also damage the tube that sends urine out of the body
(urethra), especially for men. A straddle injury may also hurt the area between the genitals and the anus
called the perineum. Severe injury can cause breaks in bones in the pelvis. Falling on a sharp object can
cause more severe damage to the area and damage to internal tissues, such as the vagina or rectum.
https://www.saintlukeskc.org/health-library/understanding-straddle-injury

Dikatakan Straddle injury yaitu ketika trauma terjadi pada area selangkangan antara paha dengan paha.
Straddle injury dapat terjadi akibat mengangkangi benda (objek) keras, atau mengalami kecelakaan seperti
jatuh ke palang sepeda.

Cedera ini dapat menyebabkan kerusakan pada alat kelamin bagian luar. Pada wanita yang paling sering
adalah vulva. Pada pria yang paling sering adalah skrotum, testis, dan penis. Daerah pada selangkangan
akan memar, berdarah, dan nyeri. Straddle injury juga dapat mengakibatkan cedera pada uretra, terutama
untuk pria. Straddle injury juga dapat melukai area antara alat kelamin dan anus yang disebut perineum.
Cedera yang parah dapat menyebabkan patah tulang di panggul. Trauma akibat benda tajam dapat
menyebabkan kerusakan yang lebih parah pada daerah selangkanan seperti tulang pelvis dan kerusakan
pada jaringan internal, seperti vagina atau anus.

In this study, coital trauma constituted 0.34% of all gynaecological patients seen. This is lower
than 0.7% reported in Abraka6 and Calabar7, Nigeria. The lower incidence may be related to the
shame and secrecy attached to the condition which makes most cases to linger in silence and only
a few severe cases and those due to rape do report to the hospital for medical help3,9􀀑

Dalam penelitian ini, trauma coital merupakan 0,34% dari semua pasien ginekologi yang terlihat.
Ini lebih rendah dari 0,7% yang dilaporkan di Abraka6 dan Calabar7, Nigeria. Insidensi yang lebih
rendah mungkin terkait dengan rasa malu dan kerahasiaan yang melekat pada kondisi yang
membuat sebagian besar kasus menjadi berlama-lama dan hanya beberapa kasus yang parah dan
mereka yang melakukan perkosaan melaporkan ke rumah sakit untuk bantuan medis3,9􀀑3

However, coitus sometimes results in more extensive lacerations of the female genital tract causing
profuse life-threatening vaginal bleeding and requiring immediate intervention [7]. It has been
reported that nonconsensual intercourse results more often in severe injuries [6,8,9].
The common predisposing factors to coital injuries include rough coitus, first sexual intercourse,
harmful positions such as dorsal decubitus position, peno-vaginal disproportion, and use of
aphrodisiacs as vaginal lubricant and inadequate emotional and physical preparation of women for
sexual intercourse [2,3,9]. Others include post-menopausal, vaginal atrophy, pregnancy,
puerperium and congenital and acquired shortness of the vagina [1].5

It has been reported that lacerations are most frequently located in the posterior fornix, posterior
and lateral vaginal wall more often on the right than the left. This may be due to the fact that during
coitus the lower third of the vagina contracts whilst the upper two thirds expand and lengthen, the
uterus rises ventrally thereby exposing the posterior fornix to direct trauma by the glans penis.
Furthermore, as the right fornix is usually deeper than the left fornix it is more likely to
accommodate the glans penis and be stretched by it. In addition, the poor fascial support of the
upper vagina especially the posterior fornix makes it very vulnerable to injury during coitus.1

Telah dilaporkan bahwa laserasi paling sering terletak di forniks posterior, dinding posterior dan
lateral vagina dan lebih sering di kanan daripada kiri. Hal ini mungkin disebabkan oleh fakta bahwa
selama koitus sepertiga bawah vagina berkontraksi sementara dua pertiga bagian atas
mengembang dan memanjang, uterus naik secara ventral sehingga mengekspos forniks posterior
ke trauma langsung oleh glans penis. Laserasi sering terjadi di dinding posterior vagina kanan
karena forniks kanan biasanya lebih dalam daripada forniks kiri, maka lebih mungkin untuk
menampung penis glans dan melebar. Selain itu, dukungan fasia yang buruk pada vagina bagian
atas terutama forniks posterior membuat sangat rentan terhadap cedera selama koitus.1