The major difference between female and male genital injuries lies in the nature of the respective reproductive systems. The male system is nearly all external, while the functional aspects of the female system are nearly all internal. This is important because depending on the severity of the issue, when females undergo genital trauma during war they have a much lower chance of needing extensive surgery, hormone replacement therapy, and typically do not lose sexual function.
Until recently, the military did not recognize genital trauma as a war related injury for which a soldier could receive benefits. It now defines genital trauma in females as “the anatomical loss of the vulva [external female genitalia], uterus or vaginal canal, permanent loss of use of the vulva or vaginal canal, anatomical loss of one or both ovaries, permanent loss of use of both ovaries and total and permanent loss of urinary-system function” (Campbell, K 2012).
The most common type of surgery necessary when females experience genital trauma in war is a vaginal reconstruction, which can be broken down into three other surgeries depending on the severity and location of the injury. If only the external areas are injured, and the damage is mild a labioplasty can sometimes be used to reform the labia and reduce the mangled appearance. However, in severe cases of external injury a vulvectomy may be required, which includes the removal of the labia majora and minora. When the damage is to more than just the external and reaches the vaginal canal a more invasive surgery is necessary. Vaginal reconstructive surgery has many different forms and is determined by the surgeon and type of injury. These surgeries aim to repair the damaged tissue, make sure the urethra is in place and functioning, and restore sexual function to the patient. Because the vaginal canal is internal, damage to this area is less likely than damage to the vulva. However, the vaginal canal is incredibly vascular, and thus injury to it has a higher risk of hemorrhage and other complications. Neither of these surgeries requires use of Hormone replacement therapy.
When an injury is very severe, women sometimes, albeit rarely, sustain trauma to their internal reproductive organs. This is a major problem because the internal system lies in the abdominal cavity, making these types of injuries much more severe and harder to repair. These are typically caused by extreme explosions and gun shots. Most of the time when an injury is this severe, salvaging the damaged organs is not probable due to the extreme nature and urgencyof the situation. If just the ovaries have been damaged, typically a result of gunshot or other penetrating injury, a partial hysterectomy can be done. A partial hysterectomy is an invasive surgery where one or both of the ovaries are removed (Hysterectomy Induced Menopause, 2012). This causes the loss of maturing follicles, and has symptoms the mimic menopause in women. Hormone replacement therapy is needed to help reduce these symptoms and maintain secondary sexual characteristics(Hormone Replacement Therapy, 2012). If the injury is to the uterus, as a result of an explosion or penetration wound, a full hysterectomy is necessary. This is the removal of the uterus and ovaries. Like a partial hysterectomy, this will require HRT. These surgeries do not cause lack of sexual function alone; however they are often paired with external genital injuries which can result in loss of sexual function.
Hormone Replacement Therapy:
Hormone replacement therapy in women is similar to that in men but uses a combination of estrogen and progestin. It is used orally, with a skin patch, or with a cream. It is usually necessary following a hysterectomy. When the ovaries are removed, the follicles that they store are removed with them. This results in a lowering of estrogen levels. Although your body may still be able to produce FSH, there are no granulosa cells for them to act on, and thus no estrogen is being produced here. The adrenals will continue to secrete estrogen in the absence of the ovaries, but they cannot compensate for the now missing ovaries. Progesterone is a hormone secreted near the end of the menstrual cycle due to the feedback system between estrogen, GnRH, LH and FSH and the transformation of granulose cells to luteal cells. When the ovaries have been removed the body is thrown into medical menopause and thus the menstrual cycle ceases immediately. Progestin is a progesterone derivative used in HRT to account for the lack of progesterone.
Why are these hormone replacements needed? When going through natural menopause, the symptoms can range from mild to severe, but nearly all women who undergo a hysterectomy experience severe symptoms. These hormone replacement therapies reduce the shock to the body and serve some of the important functions these hormones would naturally. Some of the major effects women experience without HRT are hot flashes, abdominal weight gain, mood swings, decreases in breast size, thinning of hair, sleep disturbance, vaginal dryness, decreases libido and more (Mayo-Clinic, 2012). HRT can help reduce these symptoms which can become even more severe in younger patients due to the lack of these hormones for a longer period of time than those who undergo natural menopause. Estrogen and progesterone also help women protect against diseases like osteoporosis, heart disease, and Alzheimer’s(Hormone Replacement Therapy, 2012). The longer a patient goes without these hormones the more their chance of having one of these diseases gets, and HRT is often recommended to reduce these risks.