Vulvar burns, scalds, and chemical injuries

　　First, Etiology

　　1, Chemical burns.

　　2, Electric burns generally occur due to carelessness in using electricity or mistakes in the equipment or circuitry.

　　3, Industrial gas burns, scalds from boiling water.

　　4, Firework burns.

　　5, Iatrogenic burns.

　　6, Sexual abuse burns.

　　Second, Pathogenesis

　　1, Chemical burns can occur when corrosive substances are mistakenly placed inside the vagina during the treatment of vulvar and vaginal diseases, causing ulcers or ulcerations of the vulvar skin, vaginal mucosa, and cervix; children or psychiatric patients placing corrosive substances inside the vulva and vagina; placing corrosive substances inside the vulva and vagina during a suicide attempt; or during sexual abuse. Weibeland Rheindt reported 45 cases of chemical burns of the external genitalia, most of which were used for illegal abortions, while some were used for contraception, treatment of sexually transmitted diseases, and reduction of vaginal discharge, or accidental insertion of the drug into the vagina. The corrosive substances used include phenol (carbolic acid), formaldehyde, sulfuric acid, iodine preparations, and ammonia. Half of the patients had suicidal tendencies and inserted mercuric chloride into the vagina, of whom 15 died due to mercury toxicity. Nallathambi et al. reported a case of a patient who attempted suicide using a cleaning agent, resulting in injuries to the perineum, rectum, and colon.

　　2, Electric burns occur when the current encounters resistance in the external genital tissue, producing heat that causes protein coagulation or carbonization, thrombosis, and other conditions, known as external genital electric burns. Moreover, the tissue cells along the current conduction path can also be damaged by electrolysis, leading to deterioration and necrosis.

　　3. Industrial gas burns, scalds from hot water McDougal reported 197 cases of patients with perineal burns caused by hot gases or hot water. Due to the failure of parents to take care of the child, the child's buttocks were sat in a hot water pot, or the child knocked over a kettle of hot water, causing burns to the buttocks and perineal skin. The degree of burns can be categorized as first, second, and third degree. They can cause secondary infection, perineal scar spasms, affect future sexual intercourse function, and cause perineal stenosis during delivery.

　　4. Fireworks burns Mithoff reported a case where a 26-year-old mental patient ignited fireworks and inserted them into the vagina, causing damage to the lower genital tract. In rural areas, infants and young children were scalded by placing them near a fire pot or using a hot water bag for warmth.

　　5. Iatrogenic burns due to the use of laser and electrocautery to treat perineal diseases can cause perineal burns. The British medical center reported that over 10 years, they treated 35 patients with iatrogenic perineal and vaginal injuries. Perineal injury was caused by perineal irradiation to promote wound healing.

　　6. Sexual abuse burns Vighand Bartha reported a case where a husband burned his wife's perineum and vagina out of jealousy, and the United States medical center also reported burning the lower genital tract as a means of sexual abuse.

　　First, early complications

　　1. Mortality rate:

　　The American Burn Association statistics show that the mortality rate of perineal burn patients is as high as 67%, and most patients do not die from complications of the urogenital tract.

　　2. Infection:

　　Large-area burns can lead to dysbiosis of the reproductive tract flora and long-term indwelling urinary catheters, causing perineal infection, urinary tract infection, sepsis, and septicemia. Urine bacterial culture should be performed routinely, and the urinary catheter should be changed once a week to minimize the time of catheter indwelling. McDougal found that 72% of patients with perineal burns had positive urine cultures, and the same bacteria were cultured in the blood of 50% of the patients.

　　3. Injury to surrounding structures:

　　They can directly and indirectly cause injury to the bladder, rectum, and pelvic bones.

　　Second, late complications

　　1. Formation of perineal scars:

　　Mild perineal burns can cause changes in the quality of the perineal skin, altering the humidity and pigmentation of the perineum. Severe burns can lead to perineal deformities, affecting excretion and sexual life.

　　2. Perineal contraction:

　　One of the common complications of perineal burns is contraction, which affects the child's development. Alghanem reported that 60% of the children with burns experienced perineal contraction, which required relaxation. Relaxation is achieved by using local skin flaps or skin grafts to restore the original position of the reproductive organs. In cases of vaginal contraction, a vaginal model or surgical relaxation should be used, with scar tissue excision, skin grafting, or skin flap for vaginal reconstruction. Weibel reported on patients who survived burns of the reproductive tract, most of whom had varying degrees of vaginal stenosis.

　　3. Urethral stenosis:

　　Narrowing of the urinary meatus can cause difficulty in urination, which requires surgical relaxation.

　　4. Rectal stenosis:

　　It can cause long-term difficulties in defecation and fecal incontinence. Expansion and scar excision should be performed.

　　5. Rectal prolapse:

　　Approximately 5% of children with perineal burns experience rectal prolapse, mainly due to perineal malnutrition.

　　6. Psychological impact:

　　Deformities, pain, difficulty defecating, and loss of sexual function greatly harm the patient's self-confidence. Gottlieb reported that 25% of patients lost libido or climax.

　　The clinical manifestations of fever in vulvar burns, scalds, and chemical injuries include congestion, abdominal pain, hypersensitivity, erythema burns, secondary infection, eschar burns, severe pain, sharp pain, ulcers, and skin necrosis.

　　1. Safe medication, electricity use, protect children, operate medical equipment correctly, and actively treat psychiatric patients.

　　2. Prevention of vulvar contraction: Special attention should be paid to the contraction of perineal tissue in patients with severe vulvar burns. Use splints to abduct the buttocks; active and passive hip joint movements; early activity of the patient can prevent perineal contraction. If vaginal burns are present, vaginal molds should be placed to prevent vaginal stenosis.

　　Common examination methods for vulvar burns, scalds, and chemical injuries: blood routine, drug sensitivity test, colposcopy, vaginal secretion examination, stool routine, urine routine, and routine gynecological examination of the vulva.

　　1. Foods to avoid for vulvar burns, scalds, and chemical injuries: spicy and irritating foods should be avoided.

　　2. The best foods to eat for vulvar burns, scalds, and chemical injuries should enhance nutrition, eat more protein-rich foods such as fish, eggs, soy products, and appropriately increase calcium. Drink plenty of water, eat more vegetables and fruits such as green vegetables, celery, bananas, etc.

　　1. Safe medication, electricity use, protect children, operate medical equipment correctly, and actively treat psychiatric patients.

　　2. Prevention of vulvar contraction: Special attention should be paid to the contraction of perineal tissue in patients with severe vulvar burns. Use splints to abduct the buttocks; active and passive hip joint movements; early activity of the patient can prevent perineal contraction. If vaginal burns are present, vaginal molds should be placed to prevent vaginal stenosis.