# Genital injury (including circumcision) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: MSF Essential Drugs 2024 - paracetamol (oral) · Tullington JE, Blecker N. Lower Genitourinary Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan- . [Updated 2023 May 8]. Bookshelf ID: NBK557527. PMID: 32491459. - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) ## Treatment metadata - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text GENITAL INJURY (INCLUDING CIRCUMCISION) Sources: MSF Essential Drugs 2024 - paracetamol (oral) · Tullington JE, Blecker N. Lower Genitourinary Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan- . [Updated 2023 May 8]. Bookshelf ID: NBK557527. PMID: 32491459. Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Blunt scrotal trauma: severe pain, swelling that comes on fast, and nausea [nausea] - Penile fracture: the patient describes a sudden bend, a snap or pop, sharp pain, and instant loss of erection - Urethral injury: inability to pass urine, or a sense of suprapubic fullness - Visible blood in the urine points towards a genitourinary injury [blood in the urine] - Men with penile fracture often come late because they are embarrassed SIGNS - what you find (9) - Urethral injury: blood at the meatus, perineal bruising or tear, scrotal haematoma, a prostate riding high on rectal exam, or a catheter that will not pass [bruising · hematoma] - A perineal haematoma should raise concern about injury to pelvic organs including the urinary tract [hematoma] - Gross blood found on rectal examination indicates bowel injury - Any instability of the pelvis on examination means there is a fracture - Penile fracture: swollen, bruised penis that leans away from the side of the tear - Swelling held within Buck fascia gives the eggplant deformity of the penis [visible deformity] - Bruising is inconsistent, and haematoma size does not track how badly the testis is injured [bruising · hematoma] - Pain and a scrotal hematocele, blood and fluid in the tunica vaginalis, often limit examination - Female genital trauma: bruising, swelling or tears of the vulva, and lacerations or impalement seen on speculum exam [bruising] TESTS (9) - Retrograde urethrogram is indicated whenever urethral injury is suspected - Cystography, plain or CT, is the first-line imaging for a suspected bladder injury, and contrast seen outside the bladder confirms it - Gross haematuria with a pelvic fracture or blunt trauma is an absolute indication to evaluate the lower urinary tract - Scrotal ultrasound comes first for suspected testicular rupture, reported at 100% sensitivity and 93.5% specificity - Ultrasound features of a ruptured testis: patchy parenchymal echotexture and a break in the tunica albuginea - Penile fracture needs no imaging when history and examination fit; ultrasound is used if the picture is unclear, MRI if still equivocal - A raised serum lactate, with a base deficit on arterial gas, flags bleeding; the first haemoglobin and haematocrit miss it - FAST scanning shows free fluid but cannot tell blood from bowel contents - On contrast CT an arterial-phase blush means active arterial bleeding, and the delayed phase reveals urinary tract injury IF NOT THIS - what else fits (10) - Renal injury - Ureter injury - Pelvic fracture - Rectal injury - Vaginal laceration - Abdominal injury - Retroperitoneal haemorrhage - Urethral stenosis - Urinary calculi - Fournier gangrene Source StatPearls "Lower Genitourinary Trauma" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Standard analgesic dose for post-procedural or minor genital trauma pain; dosing is unchanged by the cause of the pain. Caution Simple analgesic for post-circumcision or minor genital injury pain. Refer urgently for heavy or uncontrolled bleeding, inability to urinate after circumcision, signs of wound infection or fever, or suspected penile fracture/testicular rupture - paracetamol is for pain control only, not a substitute for surgical assessment when red flags are present. Do not exceed 4 g in 24 hours. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)