Zipper and other common causes of genital injuries
Published 3:47 pm, Tuesday, August 27, 2013
It can get caught in a zipper, slammed by a toilet seat or fall victim to overzealous grooming with sharp instruments.
If anyone's genitalia have been snipped, snagged or crushed hard enough to warrant a trip to an emergency room in the U.S., a team of dedicated UCSF urologists has painstakingly documented the details in five medical journal articles published over the past year with additional studies on the way.
The first study, published in November in the Journal of Urology, looked at product-related injuries in adults and was the largest ever to look at "genitourinary" injuries, or those involving the genitals, urinary tract or kidneys. The injuries mainly involved an unfortunate encounter with a piece of sports equipment, clothing, furniture or other item.
Using the National Electronic Injury Surveillance System, which is a national probability dataset based on a sampling of U.S. hospital emergency departments, the researchers found more than 142,000 adults went to the ER between 2002 and 2010 for these types of injuries.
In December, the researchers followed with another Journal of Urology article that focused on pubic injuries that occurred during grooming. Razors are the key culprit, and researchers found the problem is clearly on the rise - increasing fivefold during the eight-year study period.
In January, the team published an article that looked at genital injuries in children. In March, they produced a British Journal of Urology article devoted entirely to zipper mishaps, a problem immortalized in a scene from the 1998 comedy "There's Something About Mary." An article in that same journal in June, bluntly titled "No Small Slam," examined the consequences of a toilet coming in sudden contact with the penis.
Dr. Herman Singh Bagga, a UCSF urologist and one of the main study authors, explained how the doctors became so intrigued by these injuries and why they published such a large volume of articles on the subject. This conversation was edited for space and clarity.
Q: What led you to start researching these types of injuries?
A: As urological surgeons, we deal with all sort of genitourinary problems, but generally we deal with trauma - major trauma like accidents and other things where people end up in the emergency room and then go into surgery. But then we realized we're probably missing a lot of lower-acuity injuries and likely have a false sense of what's really going on out there.
The first step in injury prevention is to identify the injury, and that first step had never been done properly. We looked at the common injuries and the common mechanisms. We were looking for opportunities where we could make systemic change and we found a couple.
Q: What were some of the more common injuries you found?
A: We found the number one cause for penile injuries in adults was actually a zipper. It wasn't insignificant; almost 18,000 folks, both adults and children had showed up in the ER (between 2002 and 2010) with zip-related injuries. This is important for (physician) training because the next generation of doctors needs to know how to release the zipper from the penis. They need to learn mechanically how you unwedge it from the penis without damaging it.
Interestingly, an increasing problem is kids getting hit by toilet seats. The seat comes down and crushes the tip of the penis. This can also be a problem in older adults, but for children you're more in control of their behavior. We found anecdotally that kids, while being toilet trained, tend to rest the penis on the rim of toilet. So, while they're training, one thing you can do is advise a kid not to do that. There are also those slow-close toilet seats. In adults, you don't have quite as much control over their behavior, but it's important they're aware of the risk of injury.
Q: What were some of the other areas where you found opportunity for change?
A: We found there's a lot of sporting-related injures, which is not surprising if you engage in sports. Bicycles are the number one cause of genitourinary injuries. Usually it's someone falling and hitting the bar, so there are opportunities to make modifications. For children, you could put one of those soft tubes over the bar. That's a simple intervention that could reduce the number of injuries.
We also looked at injuries related to having a solitary kidney or solitary testicle. Those are organs where you can survive with just one, but those kids are often discouraged from sports or other activities. We tried to stratify the data and see what the reality was in terms of injuries to the solitary kidney or scrotal sac, and the good news is it's not that common, so there's really not much reason to tell a child they can't play sports. And the benefits of them being active far outweigh the relatively small risk of injury.
Q: How did the injuries vary by age?
A: Among young adults, aged 18 to 24, it's mostly sports related, and that's not unexpected. About 40 percent of young men and women versus 10 percent of older adults have sports-related injuries.
But when you look at older people, as they age they had a greater number of bathroom-related injuries. They slip in the tub or fall against other furniture in the bathroom, so it's important they have nonslip pads. For the really young kids, they also had bathroom-related injuries but more often from scalding and burns. So when you put in a kid in bath, obviously it's important to be careful (about water temperature).
When we looked at different age ranges, we found the young adults have been having shaving-related injuries and that it's increasing over time. That's likely due to cultural changes in the way people groom their hair, but it's kind of taboo to talk about. Perhaps we need to make sure that if they're going to participate in grooming, they should use an electric trimmer rather than going at it with scissors or razors.
Q: What are the most bizarre injuries you found and were any sex related?
A: We were expecting a lot of injuries from sex toys, but we did not find a whole lot of that. Among young people, those accounted for less than 3 percent of injuries. I think they may buy these products in sex shops and maybe someone there informs them about the products. We concentrated more on things that had a product-related aspect to it, so just sex injuries in general, we didn't really document those. Females had insertion (toy) injuries and males had these rings around the penis. Some were associated with injuries mainly because they kept it on too long.
Q: Your research has received attention across the globe. Are you surprised at the level of interest?
A: People talk about these things and maybe giggle about it at first, but when you see the data it's perhaps not as rare as you think. And it's definitely interesting to people.
The data was there and this was not an expensive undertaking. It was really just time. It took time to go through the data and look at these injuries. The government has done a great job at documenting these things, but it can be a little overwhelming. So we just looked for trends and products in which we could work with companies and offer (safety) interventions. We have not been approached by any companies in particular, but maybe we need to take the active approach and contact them. That's probably the next step.
Q: Speaking of the next step, what's next for you and the research team?
A: We're actually about to publish another paper. I've just submitted a paper for sports-related injuries. We were looking at sports overall to see what sports are particularly dangerous, but then because we found so many bicycle injuries across all ages - kids and adults - that we're focusing another paper just on bicycle-related injuries.
We're also looking at playground injuries. The thought was generally these mostly occur on straddle toys - rocking horses, see-saws, things like that - but the preliminary results show that isn't the case. It's more on monkey bars and slides where kids are being more aggressive.
My colleague, Dr. (Benjamin) Breyer, is actually planning a pretty large study looking more deeply into grooming-related injuries. We're seeing this show up in the emergency department, but we also think many people are not showing up due to stigma or embarrassment. He's looking at when injuries happen and why and what's the cultural reason behind it - is it thought to be more hygienic, more sexually attractive? Once you understand the epidemiology and thought behind these things, then you can enact change.
An estimated 17,616 patients - virtually all male - showed up in U.S. emergency departments with zipper-related injuries between 2002 and 2010, accounting for nearly 20 percent of all penile injuries.
In children, 36 percent of genitourinary injuries were associated with sporting equipment, 15.5 percent involved furniture and 12 percent were clothing related. Toilet seat slams were the most frequent cause of injury to the penis, followed by the zipper.
The vast majority of grooming injuries - 83 percent - involved razors, and women were most affected. The proportion of scissor-related injury was greater among men: 22 percent versus 7 percent.
Of crush injuries involving toilet seats, 82 percent occurred in children aged 2-3 years old.
How to avoid injuring your nether regions
-- Be more attentive in using zippers or, for children, consider elastic straps or Velcro-fly trousers.
-- Non-slip bath mats and safety railings in the bathroom can reduce chances of slipping and falling, a common cause of genital injuries in older people, especially men.
-- Parents of potty-training boys may want to install a slow-release lid on toilets to prevent injuries from a falling lid.
-- If you groom your pubic hair, take your time and use an electric razor to prevent cuts and infections.