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Fast Five Quiz:
Sexual Intercourse-Related Injuries

Injuries related to sexual intercourse are common but often untreated because of the patient's embarrassment. Test your knowledge of these injuries and how best to treat them with this short quiz.

Quiz: Can You Recognize and Treat Sexual Intercourse-Related Injuries?

Richard H. Sinert, DO

March 13, 2015

Although widely underreported and untreated for somewhat obvious reasons, injuries related to sexual intercourse are common. These range from incidental sprains and strains to more significant conditions such as penile fractures. Are you familiar with these common injuries and how best to treat them? Test your knowledge with this short quiz.

Spoiler

Which of the following sexual positions is associated with the highest incidence of penile fracture?

Missionary position

Female-dominant position

Side-by-side

None of the above

The frequency of penile fracture is probably underreported in the published literature. Trauma during sexual relations is responsible for approximately one third of all cases; the female-dominant position is most commonly reported. The mechanism of action may lead to embarrassment, causing patients to avoid seeking treatment and contributing to late presentation.

For more on penile fractures, read here.

Muscle strains or sprains in the lower back are common injuries during sexual intercourse. Which of the following indicates potential neurologic involvement in the presence of suspected lower back injury?

Positive flexion abduction external rotation (FABER) test findings

Negative Oppenheim test results

Negative Babinski test results

Positive Lasègue test results

Evaluation of the lower extremities should include a motor examination, a sensory evaluation, and reflex testing at the knees and ankles. The straight-leg raising test (Lasègue test) helps to evaluate disc involvement, sciatica, or a neurologic deficit. A positive Patrick test points to a sacroiliac joint inflammation, but this test should be negative in lumbosacral sprains and strains.

For more on lower back sprains and strains, read here.

Neck sprains and strains are among the most common sexual intercourse–related injuries seen in the emergency department. Which of the following imaging studies is the best noninvasive and detailed imaging study for evaluating discs and the spinal cord?

MRI

CT scanning

Bone scanning

Videofluoroscopy

Overall, MRI is the best noninvasive and detailed imaging study for evaluating the status of the discs and spinal cord. Order MRI if detailed analysis of spinal structures (eg, spinal cord, disc) is indicated. CT scanning may be used as an alternative to MRI in patients with claustrophobia, although disc imaging with CT scanning offers low resolution. Videofluoroscopy is a controversial study used to evaluate increased, decreased, or abnormal segmental movement of the cervical spine. Bone scanning is indicated if a spinal tumor, infection, or occult fracture is suggested.

For more on the workup of cervical sprain and strains, read here.

Which of the following is the most common cause of testicular trauma?

Penetrating trauma

Burn

Blunt trauma

Degloving trauma

Blunt trauma refers to injuries sustained from objects applied with any significant force to the scrotum and testicles. This can occur with various types of activity. Penetrating trauma refers to injuries sustained from sharp objects or high-velocity projectiles. Degloving injuries (or avulsion injuries) are less common. With these, scrotal skin is sheared off—for example, when a testicle becomes trapped in heavy machinery.

For more on the testicular trauma, read here.

Bumps and bruises are common injuries that result from vigorous sexual intercourse. Which of the following treatments is not indicated for a muscle contusion?

Limb immobilization

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Ice therapy within the first 48 hours

Heat therapy within the first 48 hours

In the acute phase following a muscle contusion, hematoma maturation, inflammation, necrosis of damaged myofibrils, and phagocytosis of the necrotic debris are main features. The goal of therapy is to minimize hemorrhage and inflammation and control pain. Limb immobilization with rest, ice, compression, and elevation (RICE) should be performed for the first 24 hours in patients with minor contusions and for 48 hours in patients with moderate or severe contusions.

The general recommendation is to avoid heat during the first 24-48 hours to avoid increasing the extent of hemorrhage and edema. Once the lesion has stabilized, heat may help break up the mass of blood and tissue; however, in the literature, this has been shown to be of limited benefit.

For more on the treatment of contusions, read here.

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Cite this article: Richard H. Sinert. Quiz: Can You Recognize and Treat Sexual Intercourse-Related Injuries? Medscape. Mar 13, 2015.