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Painful iv site: Superficial thrombophlebitis Information | Mount Sinai


Ask an expert: Bruising, tenderness from an IV

Q. I had an IV inserted and removed three months ago, and still have a bruise that follows my vein up my forearm. The bruise is yellowish in color and still tender to the touch. The vein also feels a little hard. How long is this supposed to last? Is this common?

A. About 25 million Americans have intravenous catheters (or IVs) placed each year. They are a very important part of medical treatment for acute illnesses, cancer, surgery, anesthesia, and trauma. IVs are used to administer fluids and to allow medications to reach as quickly and effectively as possible, via the bloodstream, the parts of the body where they work.

IV catheters can be placed in a hand, arm or leg. During the placement of an IV, a needle is inserted through the skin and into an accessible blood vessel. A plastic tube is then slid over the needle, which is withdrawn. No needle remains in your body. (So-called “butterfly” needles are an exception to this).

Some healthcare providers use a little bit of local anesthetic beforehand, with a very tiny needle, to numb the area of skin where the IV is inserted. Local anesthetic cream is sometimes applied 45-60 minutes beforehand to achieve the same effect. This is particularly helpful in the care of children.


Serious complications related to peripheral IVs are uncommon, but problems do occur, especially with prolonged use. That is why there are guidelines in different hospitals about the recommended duration that a peripheral IV should be in place.

As with any side effect or complication of health care procedures, early detection and good communication between the patient and health care provider are important. Listed below are complications of IV catheters and their treatments.

• Phlebitis: Phlebitis is a term that means inflammation of a blood vessel. Phlebitis occurs quite commonly after the insertion of intravenous catheters. In phlebitis the inflammation causes localized redness and warmth at the IV insertion site and perhaps a short distance along the course of the vein in which the IV has been placed. Most times, phlebitis is no more than a minor inconvenience.

• Thrombophlebitis: Thrombophlebitis is similar to phlebitis but a thrombus (clot) is in addition involved. As the IV cannula stays inside your body, it may irritate the vein leading the body to trigger its clotting mechanisms.

You may notice a hardened area corresponding to where a clot has formed in the vein. This kind of small clot does not have the same potentially life-threatening consequences as blood clots in the deeper and larger veins in the body. Thrombophlebitis is not usually associated with infection.

Treatment of phlebitis and thrombophlebitis is aimed at relief of the symptoms including: anti-inflammatory medicine, such as ibuprofen, acetaminophen for pain, or local heat. If the condition worsens, especially if pain or the area of redness increases, medical attention should definitely be sought.

• Septic thrombophlebitis: The vein can become infected and spread infection throughout the body via the bloodstream. If you suspect an infected vein, see your healthcare provider immediately. Hospitalization may be needed and antibiotics will be used to control the bacterial infection. You must finish the entire course of prescribed antibiotics.

• Local infection: A microscopic organism may use the tiny hole in the skin created by the IV catheter to find its way into the body, and cause an infection. If you suspect an infection, see your healthcare provider immediately. Antibiotics may be used to control the bacterial infection. You must finish the entire course of prescribed antibiotics.

• Infiltration: This occurs when the catheter unintentionally enters the tissue surrounding the blood vessel. The intravenous infusion must be stopped, obviously, to avoid putting any more fluid or medication into the tissues. Another IV may need to be started elsewhere.

• Hematoma: This happens when the catheter punctures through the vein causing internal bleeding and a collection of blood. A hematoma normally recovers over time (a few hours or days) without treatment.

• Nerve damage: It is also possible for the IV needle to penetrate and injure a nerve, and for bruising and bleeding to irritate a nerve. Nerve damage tends to repair itself in a few weeks to a few months. If you suspect a nerve injury contact your doctor.

Nurse….my IV hurts!! | Infusion Nurse Blog

You just started a PIV in the patient’s right arm and soon after, the patient complained of sharp pain and ask that the PIV be removed. What would you do?

  1. Leave PIV in and tell patient,of course it will hurt, I just stuck you with a needle
  2. Assess the IV site and if no redness or swelling is noted, leave IV in and tell patient pain will go away soon
  3. Reposition the IV catheter, apply new dressing and leave IV in.
  4. Listen to the patient and remove PIV.

There are patients who complain of discomfort or mild pain after a PIV insertion or while PIV is dwelling. Many nurses report this scenario as a difficult situation particularly in certain patients who do often have something to complain about. Many nurses report however, they do listen to their patients  and take the appropriate action.

This was not the case with an ER nurse described in this local news report. “Woman gets $927,000 for botched surgery” .  The patient complained of pain after the IV insertion and asked the nurse to remove the IV catheter. The nurse didn’t and the PIV was left in place for over 24 hours. The news report did not include details about the exact location of the PIV. One can only speculate that the IV was placed either in the antecubital fossa or in the wrist resulting in the nerve damage experienced by the patient.

Nerve injuries can result from venipuncture. The two nerves most often injured during a venipuncture procedure are the radial and median nerves. The radial nerve passes along the thumb side of the arm, from the shoulder down into the wrist area, and is in close proximity to the cephalic vein. In a venipuncture procedure, the cephalic vein is often the vein of choice for many clinicians. The distal three inches of the radial nerve, just above the thumb, is the area most often injured during the insertion of peripheral IV devices. The median nerve is the largest nerve in the arm. It runs inside the antecubital fossa and passes through the forearm into the palm of the hand. When nurses are drawing blood from the antecubital fossa or inserting peripheral IV devices, they could contact and injure this nerve. Insertion of IV catheters into the superficial veins of the inner aspect of the wrist above the palm of the hand can result in serious injury to the median nerve and carpal tunnel syndrome.

This is an unfortunate situation for both the patient and the nurse who admitted “negligence” in this case. Nerve injury related to venipuncture is one of the most common areas of malpractice involving nurses. Let’s make this a learning opportunity and keep the following in mind.

  • Listen to the patient. Like or not, that patient’s are always right!
  • Avoid areas of flexion such as the wrist or antecubital fossa when selecting an IV site. It is very tempting to use these sites because the big veins are located there but resist the urge to use it for venipuncture.
  • Remove the IV catheter immediately if patient complains of sharp pain, tingling or numbness at the site or radiates to areas near the IV site.  This is very difficulty especially in the ER where a venous access device is needed immediately to administer medications. Think about restarting another IV in another site and remove the one the patient is complaining about as soon as the patient status allows.

Cartoon from the Journal of Nurse Jocularity January 2008.

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Protect patients from IV infiltration

Suppose you’re observing another nurse as she administers meperidine I. V., and you hear the patient complain of pain and burning at the catheter site. Your colleague assesses the site and doesn’t note edema, leakage, or changes in skin temperature or color. So she reassures the patient by explaining that many people complain of pain when receiving this drug.

What would you think of the care this nurse provided? Many nurses would say she performed appropriately. However, they would be wrong—and the patient could be headed for serious complications from infiltration.

A venipuncture may cause mild, transient pain, but I.V. fluid and drug administration shouldn’t hurt or burn. If the drugs are diluted and administered correctly, blood flow around the catheter is adequate to dilute them further, and if the catheter is properly immobilized, an infusion won’t cause pain. Discomfort or pain during an infusion indicates vein damage that will lead to infiltration.

Means of escape

Before reviewing how I.V. fluids and drugs escape the vein, let’s distinguish infiltration from extravasation, a related complication. The difference between the two is in the solution. According to the Infusion Nursing Standards of Practice written by the Infusion Nurses Society (INS):

  • Infiltration is the inadvertent administration of nonvesicant drugs or fluids into the subcutaneous tissue.
  • Extravasation is the inadvertent administration of vesicant drugs or fluids into the subcutaneous tissue.

Fluids and drugs can escape from the vein by several mechanisms:

  • a puncture of the posterior vein wall during peripheral I.V. catheter insertion.
  • catheter or arm movement causing the catheter tip to erode the vein wall
  • thrombosis or restrictions to normal venous blood flow proximal to the insertion site
  • inflammation, which widens the gaps between cells of the vein wall, allowing fluid to leak out.

Preventing infiltration

To prevent infiltration, follow the standards of the INS and the policies and procedures of your facility. Consider practicing your venipuncture skills on well-hydrated patients who don’t have chronic conditions. Then, move on to patients with veins that are more difficult to access. Aging and conditions such as diabetes and hypertension change the vein-wall structure. And patients receiving frequent or long-term infusion therapy may present challenges for nurses without extensive venipuncture experience.

Avoid the veins in the hand, wrist, and antecubital fossa as insertion sites because of the high risk of serious complications from catheter movement. Instead, use the veins of the forearm, where the bones provide a natural splint to prevent vein trauma from arm movement. (See Documenting I.V. catheter insertion by clicking on PDF icon above.)

You can find information on the proper infusion techniques for specific drugs in I.V. drug handbooks. Unlike drug handbooks that cover all administration routes, an I.V. drug handbook provides information on dilution, infusion rates, compatibility, monitoring, and precautions for the I. V. route.

Looking for signs of infiltration

Recognizing the early signs and symptoms of infiltration can limit the amount of fluid that escapes into the tissue. Such signs and symptoms include local edema, skin blanching, skin coolness, leakage at the puncture site, pain, and feelings of tightness. Compare the contralateral limb for differences in circumference. Look above and below the venipuncture site. Also, check the opposite side of the affected limb: it may be the only place where you can see that fluid is escaping from the posterior vein wall.

Consider the timing of signs and symptoms, too. Your patient may feel pain initially, but depending on the drug and the patient’s individual response, the pain may subside after a few minutes. Isotonic or hypotonic fluids and drugs may be quickly dispersed in the tissue and produce small amounts of swelling.
Hypertonic fluids will pull fluids from cells through osmotic fluid shifting, causing more interstitial fluid and compounding the problem.

To determine needle position, aspirate the cathe­ter for a blood return. Slowly and gently withdraw the syringe plunger and look for a brisk blood return. As an alternative, lower the fluid container below the venipuncture site and look for blood in the tubing.

Another alternative is the tourniquet test. Apply a tourniquet several inches above the venipuncture site and observe the gravity fluid flow. Compression from the tourniquet should stop or significantly slow the fluid flow. If you see little or no change, the fluid could be leaking into the subcutaneous tissue rather than flowing into the vein.

Don’t count on infusion-pump alarms to detect infiltration. Pumps don’t have mechanisms to detect infiltration, and they’ll continue to force fluid into the catheter, regardless of where it goes.

If undetected, infiltration can become so severe that it affects the neurovascular status of the limb. Assess the patient for sensation, ability to move his fingers, and a palpable radial pulse. Continue this assessment during the infusion because these changes may not occur immediately. Excessive fluid in one or more compartments of an arm can cause damage to nerves, arteries, and muscles and requires immediate surgical intervention to prevent a permanent loss of function. (See Complications of infiltration by clicking on PDF icon above.)

Managing infiltration

If you identify signs and symptoms of infiltration, immediately stop the infusion and remove the catheter. If the I.V. site is the only one you have for a patient with poor veins, you may be reluctant to remove the catheter. But continuing the infusion despite the signs and symptoms of infiltration will create a much greater problem than establishing a new I.V. site, even in poor veins.

A common intervention for infiltration is thermal manipulation at the site. For certain nonvesicant drugs, you’ll apply heat to increase blood flow and the amount of interstitial tissue in contact with the fluid. For hypertonic or hyperosmolar fluids, apply cold to restrict contact with additional tissue, thus limiting the tissue affected by osmotic fluid shift. For isotonic or hypotonic fluid, choose heat or cold based on patient comfort.

Another intervention is injecting an antidote. Hyaluronidase, a protein enzyme that breaks down the subcutaneous cellular components to allow fluid reabsorption, is probably the best choice. Several brands are available: Amphadase, a bovine product; Vitrase, an ovine product; and Hylenex, a human recombinant product that avoids the problems associated with animal-derived products.

If large amounts of fluid have infiltrated, the patient may need surgical decompression with a fasciotomy—immediately.

Observe and protect

Your skilled assessment and intervention can protect your patients from the complications of infiltration. And your skills and quick action can also protect you and your facility from legal liability.

To help ensure these protections, be proactive. Review your facility’s policies and procedures for preventing, recognizing, and managing infiltration. If they aren’t correct, coherent, and current, initiate the process to improve them.

Selected references

Infusion Nurses Society. Infusion Nursing Standards of Practice. J
Infus Nurs
. 2006;29(1S).

Kagel E, Rayan G. Intravenous catheter complications in the hand and forearm. J Trauma. 2004;56:123-127.

Tiwari A, Haq A, Myint F, Hamilton G. Acute compartment syndromes. Br J Surg. 2002;89(4):397-412.

Willsey D, Peterfreund R. Compartment syndrome of the upper arm after pressurized infiltration of intravenous fluids. J Clin Anesth. 1997;9(5):428-430.

See also Follow standards of practice to prevent infiltration, a list of key points on how to prevent infiltration based on the Infusion Nursing Standards of Practice by the Infusion Nurses Society.

Lynn Hadaway is president of Lynn Hadaway Associates, Inc. in Milner, Georgia.

Information About Children and IVs | Way to Grow

What is an “IV”?

“IV” stands for “intravenous,” which means inside the vein. Fluids and medicines are often given into the veins through a catheter (a hollow plastic tube). The catheter is in the vein the needle is removed. The IV catheter is sometimes connected to a tubing with a bag of fluid or blood. The tubing will be attached to a special machine that pumps the fluid into the vein at a set rate. Sometimes an IV monitoring cable will be placed beside your child’s IV that is attached to a machine that will monitor the IV site. The monitor looks for signs of infiltration. An infiltration occurs when fluids leak out of the vein into the surrounding tissue causing swelling. Infiltration can happen slowly, making it hard for the nurse to see. The monitor can detect the swelling when a very small amount of fluid has escaped into the tissue.

Infants often have IVs in the hand, arm, foot, or scalp. Children and teens often have the IV in the hand or arm. The nurse will decide the best place for your child. After the IV has been put in the vein, your child’s nurse will tape it to help keep it in place. Keeping your child’s arm or foot still may help the IV stay in place. Your child’s hand or foot may be taped to a special padded board to keep the IV from coming out. Sometimes infants and small children may need a device on their other arm or foot to keep them from pulling the IV out.

Why do some patients need an “IV”? 

  • Some medicines can only be given by IV.
  • Some medicines do not work well when given by mouth.
  • Some medicines work faster when given by IV.
  • Sometimes an IV can be used instead of shots into the arm or leg.
  • When your child cannot eat or drink because of certain tests, surgery, or if your child’s stomach is upset, an IV is often the only way to give medicine and fluids.

How is the “IV” put into the vein?

When your child’s doctor decides that an IV is needed, the nurse or clinician will put the IV in place. The child is often taken to the treatment room for this. Other staff members may also be there to help comfort your child. Child Life team members may be available to help prepare your child for procedures.

Once the IV site is chosen, a numbing/cooling spray or a Lidocaine (numbing) cream may be used in preparation for the needle-stick to help decrease the pain or discomfort. The spray works very quickly, while the cream works 30-45 minutes after it is applied. There are emergencies when IVs have to be started quickly and this type of preparation may not be possible. We will provide comfort measures without these medications in those situations.

Before the needle stick is done, the site will be cleaned with an antiseptic solution. When the skin is first punctured, it may hurt a little. A small IV tube is left in the arm or leg when the needle is removed so the fluid can get into the vein. There should be little or no pain after the needle is removed. After your child’s nurse or clinician is sure the IV is in the vein, he/she will tape it in place.

Drawing blood and starting an IV can hurt for a short time. It may take the person starting the IV more than one try to get it. The staff will be careful to help your child keep still and stay as comfortable as possible. For some younger children the fear of the needle-stick is more worrisome than the actual pain of the stick. Child Life team members may be available to help prepare for procedures.

What can parents do to help?

Some parents want to stay in the room during the needle stick and some parents choose to leave. Either way is ok! If you choose to stay in the room, you might want to help turn your child’s attention away from the needle-stick. Here are some suggestions:

  • Tell stories
  • Make funny faces at each other
  • Talk about your favorite subject at school
  • Take deep breaths
  • Sing or talk softly
  • Say or do something that you do at home when your child needs help staying calm
  • Grab hands and squeeze as hard as you can
  • Rub your child’s arm or leg
  • Sit in the bed with your child or hold them in your lap and provide comfort as needed

If you decide to leave the room please remember that:

  • Someone will be with your child to comfort them
  • You may return right after the needle-stick is done or the IV is started.
  • It is helpful to tell the staff what types of things work to help calm your child.

Taking care of your child’s “IV”

  • The place where the catheter goes through the skin will be checked often by your child’s nurse.
  • Sometimes IVs slip out of the vein and the fluid may make the skin puffy and red. If your child pulls at his IV site, steps on his IV tubing or if IV tubing gets caught on the bed rails, please let us know as these actions could cause the IV to come out of the vein causing an infiltration. Some IV fluids and medications can also irritate veins and cause pain, tenderness, and redness of the area. Some of these problems cannot be prevented, but we will check your child’s IV frequently to catch problems early. If you notice redness, swelling or pain at your child’s IV site before we do, call the nurse right away.
  • Your child may require another IV restarted in a new vein if the existing catheter is removed.
  • Your child’s doctor will decide how long the IV is needed.
  • When the IV is no longer necessary, it can be easily removed.

What if my child needs an IV for a long time, or the IV has to be replaced several times?

Your child’s doctor may choose to order a “midline” or “PICC line” to replace the IV that your child has now. Your child’s nurse will give you the Way to Grow handout #0474 for PICC or Midline Placement as needed. Our Vascular Access Team has specially trained nurses who perform this procedure. They will talk with you and your physician about a plan for pain control or sedation during this procedure.

Remember, call your child’s nurse if:

  • Your child cries and you cannot comfort him/her.
  • Your child complains of pain around the area where the IV is inserted.
  • The IV site is red or puffy.
  • You see your child pulling on the tubing or if the tubing gets stepped on or caught on something.
  • The IV pump alarms.

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child’s physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child’s physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 01/2018

Tennessee Medical Malpractice Lawyers Explain Signs and Liability

It is commonplace during a hospital visit for a patient to receive an administration of IV fluids or medications.  This could be for a seemingly innocuous visit such as dehydration due to illness, or for a more serious admission such as before or after a major surgical operation.  Through IVs, health care providers can administer a broad range of fluids such as antibiotics, for hydration, steroids, and pain medications.

In fact, IVs have become a crucial part of most hospital medical treatment and significantly improve patient care.  This is because manufacturers and medical supply companies have developed many different attachments, extensions, and valves for health care providers to use.   Thus, only one puncture in the patient’s skin is required to be made but multiple uses can be garnered from this portal.  This lowers the risk of infection during and after the hospital stay by limiting the number of open wounds on a patient’s body, and minimizes pain and discomfort the patient may have in receiving multiple injections.  Further, this permits hospital staff to inject additional medications or withdraw blood without disturbing a sleeping or critically ill patient.

However, IV injection sites are not without risks and there is a potential for Memphis medical malpractice.  Despite the small size of an IV puncture, serious injuries and even death can occur if negligently placed or maintained in a patient’s arm.  Such injuries like tissue necrosis (damaging and dying), air bubbles, and infection can cause disfigurement, amputation, and even death.  This is particularly true where the IV becomes dislodged from the vein thus causing fluids to be pumped into the patient’s surrounding tissue.

As seemingly harmless as a dislodged IV may sound, where a patient is receiving strong antibiotics, chemotherapy, steroids, or painkillers, serious injury to the surrounding tissue, veins, arteries, and nerves can occur in a short period of time.  If the patient is under sedation in a long surgical operation or in the recovery room and staff does not recognize this medical mistake, the damage may occur for an extended period of time before the patient awakens and finds the problem.

Signs that an IV has been negligently placed or maintained in a patient’s hand include the following:

  • Changes in skin color or temperature;
  • Swelling at the IV site;
  • Bruising;
  • Stretched, taut, bulging or otherwise abnormal skin appearance;
  • The IV infusion has stopped or significantly slowed;
  • Fluid or blood is leaking from the IV site;
  • Pain is present and increasing; and
  • The bandages, dressing, tape, or other fixation at the IV site is damp or wet.

While not all mistakes in IV insertion or maintenance constitute instances of Tennessee medical malpractice, there are some common occurrences which could indicate there is possible liability due to reckless, careless, or otherwise negligent conduct by a health care provider.  Some of the most common causes of IV injury include the following:

  • Improper insertion of the catheter such as wrong angle or position;
  • Multiple failed attempts to insert the IV causing “pinprick” damage to the surrounding tissue and vein, thus making it fail;
  • Use of an oversized catheter;
  • Negligent application of the fixation tape or dressing causing the IV to slip out;
  • Failing to adequately monitor the IV flow rate causing too high a flow rate and thus too high of pressure for the catheter to remain in the vein;
  • Friction, pressure, contact, pulling, or pushing of the IV, IV line, catheter, or similar IV attachment thus pulling the catheter from the vein; and
  • Negligently choosing an inappropriate, weakened, ruptured, or vein with otherwise compromised integrity to support the catheter.

Thus, if you or a loved one believes you may have suffered an IV injury due to a negligent health care provider, please contact one of our experienced Tennessee medical malpractice attorneys immediately.  The statute of limitations from the date of the act or omission is only one year and will be barred after that date.

Here at Bailey and Greer, PLLC our Tennessee medical malpractice attorneys understand how to effectively pursue your claims.  Our legal team has a proven track record of compassionately representing our clients injured in Tennessee personal injury cases which is included in our testimonials page and our successful case results.  Please contact us today to receive your free case evaluation by dialing 901-680-9777.

Since graduating magna cum laude in 2005 from the University of Memphis School of Law, Thomas has helped make a difference in the lives of victims of serious personal injury, wrongful death, and professional negligence. Thomas has extensive trial experience in both state and federal court.  Among other victories in the courtroom, Thomas obtained several impressive jury verdicts and settlements

Read more about Thomas R. Greer

IV infiltration can cause nerve damage, burns or amputation

An IV or intravenous catheter is inserted into a vein to administer fluids, electrolytes, medications, blood products, antibiotics, lipids, or nutrition directly into the bloodstream. If the catheter becomes dislodged or moves out of the vein, the fluid that was being infused through it could now leak into surrounding tissue. When that occurs, it is called an IV infiltration.

An IV line can cause an infiltration without a nurse or doctor being negligent. The catheter might have been inserted in the wrist or elbow area where the natural bending or movement of the limb could cause the catheter to move or migrate. Sometimes, IV tubing can get caught on a blanket or bed side-rail and cause the IV to fall out of the vein. However, because it is easy for an IV to move out of a vein, it is the responsibility of a nurse to frequently check the IV site to make sure the catheter is still in the correct place.

Identifying IV Infiltration

An experienced medical practitioner should be able to identify IV infiltration by sight. However, if you notice any of the symptoms of infiltration, it is important that you notify hospital staff immediately.

Symptoms that should be brought to the attention of a nurse or doctor include:

  • Swelling, skin tautness, and/or pain around the insertion site
  • Wet dressing around the IV needle
  • Blanching, cold, and clammy skin around the IV site

Nurses and hospital staff know to routinely check IVs for signs of infiltration. This may include any of the symptoms above in addition to clear indications of a problem such as a slowed or stopped infusion.

If an IV infiltrates, it should be recognized as soon as possible to prevent traumatic or permanent injuries to an arm, leg, hand or scalp. Once an IV infiltration is discovered, the fluids that are infusing must be stopped immediately. If the fluids are not discontinued, they can continue to seep into the tissue surrounding the vein, leading to additional swelling and pain in the area. What’s more, some medications or fluids can be very irritating to the tissues, and infiltration can lead to blisters, burns, necrotic, or dead, tissue or even amputation.

If too much fluid is allowed to leak into an area, in rare cases, it can lead to compartment syndrome with nerve, tissue or muscle damage. Symptoms of compartment syndrome may include persistent pain or a tingling, pins-and-needles sensation. Compartment syndrome may also cause increased swelling and tightness in the area, further increasing risks for dangerous medical complications.

Compartment syndrome is a serious medical issue that may demand immediate surgical intervention. It may also require a delay of in your original treatment, resulting in additional injury.

No Longer Receiving Medications

When an IV infiltrates, it means that the patient is not receiving any of the prescribed medication or fluids. That can lead to additional complications or ineffective treatment of an infection, electrolyte imbalance, shock, irregular heartbeat or other critical condition. In extreme cases, IV infiltration may even result in death.

If you have been injured or a loved one has died following untreated IV infiltration, you may have legal options that can help you recover damages for medical expenses and personal pain and suffering. The medical malpractice lawyers at Kline & Specter, PC can review your case to help you determine if you have cause to file suit.

Please call 800-243-1100 to schedule your free case evaluation. Our firm has more than 40 lawyers, including five who are also medical doctors – the most of any firm in the nation. We serve clients living throughout the country. We maintain offices in Pennsylvania, New Jersey, New York, and Delaware. For cases outside those states, Kline & Specter works with local attorneys in each state as applicable.

IV line infection – HSE.ie

An intravenous (IV) line is a small plastic tube that goes into your vein. It is used to give you blood, fluid or medicine.

An IV line is also known as a cannula or drip. A needle is used to put the line through your skin into your vein.

How you get an IV line infection

An IV line creates a small hole in your skin. There is a risk that bacteria will travel along the tube and into your body.


IV lines are useful but can cause problems. They can become blocked, leak fluid into the skin and cause infection.

Preventing an IV line infection

It is OK to ask a doctor or nurse:

  • if you really need an IV line. If you don’t have an IV line, you’re less at risk of getting an infection
  • to clean their hands before they put in or touch your IV line
  • to clean your skin before putting the IV line in
  • if you still need an IV line in – the longer it’s in, the greater the risk of infection

It is OK to ask someone caring for you to clean their hands.

Symptoms of an IV line infection

Symptoms of IV line infection include:

  • pain where your IV line is
  • redness or swelling near the IV line
  • crusting or scabbing appears on skin near your IV line
  • oozing fluid, blood or pus from where the IV line goes through your skin

Bloodstream infection

Septicaemia (bloodstream infection) is a serious infection. It happens when bacteria spread to your blood.

Septicaemia bloodstream infection can cause:

  • a high temperature
  • chills
  • nausea (feeling sick)
  • weakness

Tell your doctor or nurse straight away if you notice any of the above.

Causes of an IV line infection

An IV line is more likely to cause an infection in people who are already very sick.

There are lots of people in hospital with infections or superbugs. It’s easy for these to spread in hospital.

Treatment of an IV line infection

Your doctor or nurse will talk to you about taking out the IV line and any treatment you might need. This may include antibiotics.

Painful Bladder Syndrome – WMT High Tech Clinic

Non-infectious inflammation of the bladder that causes suprapubic, pelvic and abdominal pain, urinary frequency and urge to urinate with incontinence.


There are several common symptoms by which the doctor determines the disease:

  • Pain in the pelvis and perineum: the pain is usually located between the vagina and the rectum in women, between the scrotum and rectum in men.
  • Constant unbearable urge to urinate.
  • Pain during intercourse.
  • Frequent urination in small portions.
  • The predominance of night urination over daytime.
  • When the bladder is full, the urge to urinate can be accompanied by pain and discomfort, and emptying the bladder often provides relief.


Diagnostic measures for the detection of a disease are of a complex nature:

  1. First of all, it is necessary to examine the urologist and take anamnesis.The examination includes an examination to determine the condition and presence of pathology on the part of the external genital organs, the external opening of the urethra.
  2. A prerequisite is filling out a urination diary within 2-4 days before admission.
  3. Laboratory diagnostics of general urine analysis and bacteriological analysis of urine with sensitivity to antibiotics.
  4. Test with potassium salts solution.
  5. Cystoscopy – examination of the bladder wall using a special small apparatus inserted into the bladder through the urethra.
  6. Bladder biopsy. The aim of the study was to collect a fragment of the bladder wall with subsequent histological examination (examination of the tissue under a microscope).


At the WMT clinic, urologists apply all existing methods of treating the disease, developing personal therapy for each patient:

  • Drug therapy, including local administration of drugs.
  • Electrical stimulation of the pelvic floor muscles.
  • Transcutaneous and sacral neurostimulation.
  • Bladder hydro-stimulation.
  • In rare cases, when conservative treatment fails, doctors perform surgery.


Make an appointment with the urologist of the WMT clinic by phone 8 (861) 206-03-03

Nurofen Express Lady pain relievers for menstruation: instructions for use, composition, price

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1 According to the instructions for medical use Nurofen® in the form of coated tablets (200 mg), RU P N013012 / 01. According to the instructions for medical use Nurofen® Forte, film-coated tablets (400 mg).RU P N016033 / 01. According to the instructions for medical use Nurofen® Express, 200 mg, RU P N014560 / 01. According to the instructions for medical use Nurofen® Express Forte, capsules (400 mg). RU LSR-005587/10. According to the instructions for medical use Nurofen® Intensive, film-coated tablets. RU LP-003836. According to the instructions for medical use Nurofen® Express Lady, film-coated tablets (400 mg). RU LP-001984. According to the instructions for medical use of Nurofen® for children, oral suspension [orange, strawberry]. RU P N014745 / 01. According to the instructions for medical use of Nurofen® 12+, film-coated tablets, 200 mg. RU LP-001910.

2 According to the data base of LLC “ICUVIA Solutions” “Pharmatrend FPP and dietary supplements in the Russian Federation”, according to the results of the period January – November 2020, the Nurofen® brand is the leader in terms of sales in packages and in rubles in retail prices in group 02 “Analgesics “In Russia (classification” Consumer Healthcare “).

3 Planned changes in the instructions for medical use in accordance with the letter of the Ministry of Health of Russia No. 20-3 / 2565 of 23.11.2020.

* According to the instructions for medical use. The full range of indications for use is indicated in the instructions for medical use of the drug.

Treatment of caries in Samara, prices for the treatment of superficial, medium and deep caries

Anisimova Elena Yurievna

Afanasyeva Marina Alekseevna

Bolsherotov Vladimir Valentinovich

Boyarkina Alina Gennadievna

Voronchuk Igor Anatolievich

Denisov Maxim Anatolievich

Dymova Margarita Dmitrievna

Egorova Alena Alekseevna

Inozemtseva Yulia Nikolaevna

Elena Kovtun

Kramorova Daria Dmitrievna

Lemyakina Lidia Sergeevna

Levutina Yulia Olegovna

Malysheva Galina Viktorovna

Melnikova Elena Viktorovna

Muravyova Elena Vladimirovna

Nurbagandov Shamil Magomedovich

Orlov Artem Romanovich

Petrenko Alla Alexandrovna

Petrukhina Vera Vladimirovna

Ponomareva Natalia Mikhailovna

Sadaev Sergey Vladimirovich

Trestsova Vladislava Vladimirovna

Trusova Daria Sergeevna

Khakimullina Elvira Gumyarovna

Sheina Irina Pavlovna

Yurtaeva Anna Olegovna

Yankina Irina Vladimirovna


Fibroadenoma is a benign breast tumor. Palpation fibroadenoma (FA) is defined as painful (burning, stabbing pain), easily displaced volumetric formation of dense consistency, round or oval in shape. The average size of the FA usually varies from 0.3 to 1.5 cm and, as a rule, does not exceed 3 cm in diameter. The tumor has a smooth surface, smooth, wavy or large-tuberous contours, which are clearly limited and not welded to the surrounding tissues. The skin of the affected mammary gland is not changed. The tumor node is clearly felt when pressing the breast with the palm of the hand against the chest.

According to various literature sources, FA is diagnosed in 10% of the female population and debuts at different age intervals, but more often during periods of reproductive activity (on average, from 16 to 40 years).

The main etiological factor of FA is hormonal imbalance, namely hyperestrogenemia with a simultaneous decrease in progesterone levels. Those. The greatest risk of developing or increasing PA growth occurs during hormonal changes in the body (puberty, pregnancy, lactation, premenopausal and menopausal periods, accompanied by hormone replacement therapy, thyroid tumors, pathological processes in the liver, etc. )). FA consists of two types of tissues: fibrous (connective) and epithelial.

Depending on the ratio of these tissues, FA is classified into 4 types: pericanalicular, intracanalicular, mixed and phylloid (leaf-shaped) fibroadenomas. The risk of malignancy (malignancy, transition to the sarcoma of the mammary gland) in FA types I – III is absent, in contrast to type IV – leaf-shaped FA. Leaf-like FA of the mammary gland is a fibroepithelial tumor that develops from an intraductal fibroadenoma.The pathognomonic sign of this type of FA is the rapid growth of tumor formation. It is, as it were, an intermediate form between sarcoma and fibroadenoma. Due to the listed features, and, most importantly, the increased risk of malignancy, leaf-shaped FAs require immediate surgical intervention.

It should also be noted that PA can have multiple character and recurrent course. In addition, there are known clinical cases of PA reversal. Usually these are small tumors that have undergone long-term conservative therapy.

Factors dictating the need for surgical treatment of FA:

  1. Rapid tumor growth, namely, an increase in the size of the volumetric lesion in two times within 3-4 months.
  2. The presence of multiple (including bilateral) FA.
  3. Large size of the tumor, deforming the surrounding tissue of the mammary gland.
  4. The presence of pronounced or atypical proliferation of the epithelium in the tumor (according to the results of cytological examination during puncture-aspiration biopsy).
  5. Pregnancy – as a hormonal imbalance that initiates the growth of tumor tissue. The enlarged FA mechanically compresses the milk ducts, which complicates lactation and contributes to the development of pathological processes in the mammary gland (for example, lactostasis or mastitis).
  6. Phyloid (leaf-shaped tumor).

Algorithm of diagnostic actions in the presence of a tumor formation in the mammary gland (including non-palpable form).

  1. Consultation of an oncologist – mammologist.
  2. Ultrasound of the mammary glands and regional lymph nodes (including with elastography – an additional technology used during traditional ultrasound, which makes it possible to assess the elasticity of the tissues of the organ under study). The fact is that all human tissues, including those damaged by one or another pathological process, have a certain elasticity (rigidity).
  3. Mammography (sighting and additional radiographs of the area of ​​interest in frontal, lateral, or oblique projections).
  4. Puncture biopsy or trephine biopsy (diagnostic puncture under X-ray or ultrasound control, performed in order to verify the diagnosis and determine the prevalence of the tumor process).
  5. Preoperative marking of a tumor in a non-palpable form (cutaneous marking or percutaneous insertion of a “harpoon” marking needle under ultrasound or X-ray control).

The volume of surgical intervention performed for the PA of the mammary gland:

  1. Enucleation – hulling (enucleo – remove the kernel, peel from the shell). It is used in the absence of suspicion of a malignant process. In this case, the defect in breast tissue (as a complication of the operation) is minimal or absent altogether.
  2. Sectoral resection of the mammary gland – removal of a tumor formation together with the surrounding tissues of the mammary gland, followed by a cosmetic defect of varying severity, which is eliminated by various methods of mammoplasty (using an endoprosthesis or local tissues).
  3. Subcutaneous mastectomy with simultaneous reconstruction of the breast with an endoprosthesis (implant) or local tissues (for large tumor sizes or multiple FA).

General surgical and cosmetic principles have been synthesized in our center when choosing methods in breast surgery. Operations have been developed and implemented that provide not only adequate radicality, but also an excellent aesthetic result.

Burns. Features and severity. First aid

Dear parents of wonderful boys and girls, as well as their grandparents! The world around us is not only beautiful and interesting for your child, but also conceals dangerous situations for him. You are always there and will be the first to help your baby.

Summer is coming – the time of vacations and children’s vacations, which means that children will spend more time at home and on the street, in the countryside and camping around the campfire. As a dermatologist, I would like to draw your attention to a common type of injury – burns.

Burns are one of the most common types of injuries in children and adults.

Burns are thermal, chemical, electrical, radiation. Thermal burns account for more than 90% of all types – these are burns by flame, hot steam, hot or burning liquid, boiling water, burns from contact with hot objects, sunburn.Burns are especially dangerous for children and the elderly.

Babies are more likely to get burns by throwing boiling water, hot milk or soup on themselves, touching hot objects (battery, iron, electric stove, light bulb). Older children, as a rule, suffer from careless handling of fire at home or in nature.

Depending on the depth of the skin lesion, the severity of burns is distinguished.

A 1st degree burn is a lesion of the most superficial layer of the skin.A pronounced redness of the skin, its swelling develops, pains, a burning sensation are noted in the affected area. These phenomena subside within 2 days, and after a week full recovery occurs.

At a 2nd degree burn , the top layer of the skin completely dies and exfoliates, thus forming bubbles filled with a transparent liquid. The first bubbles appear within a few minutes after the burn, however, within 1 day new bubbles may form, and the existing ones may increase in size.If the course of the disease is not complicated by infection of the wound, then healing occurs in 10-12 days.

With burns of 3 degrees , the skin is affected almost to the entire depth. In this case, massive blisters with a thick membrane are formed, filled with bloody contents, tense and very painful.

A 4th degree burn is a complete death of all layers of the skin, including subcutaneous fat, as well as the underlying tissues – muscles, tendons, bones.

Each damaging factor has its own characteristics:

  1. Flame. The area of ​​the burn is relatively large, in depth it is mainly the 2nd degree. During the initial treatment of the wound, it is difficult to remove the remains of burnt clothing; unnoticed threads of tissue can subsequently serve as foci for the development of infection. The organs of vision, upper respiratory tract can be affected. Burns by fire in closed rooms are very dangerous, since burns of the respiratory tract with hot smoke, carbon monoxide poisoning are added to the damage to the surface of the body.
  2. Hot liquid. The area of ​​the burn is small, but relatively deep, mainly of 2-3 degrees.
  3. Par. The burn area is large but shallow. The respiratory tract is very often affected.
  4. Hot objects. The burn area is always limited by the size of the object and has relatively clear boundaries and considerable depth.

As a practicing physician, I would like to draw your attention to the fact that, unfortunately, in most cases, burns cause not only physical trauma and cosmetic defects, but also long-term psychological trauma.Therefore, timely first aid and specialized doctor’s are of great importance.


The first thing to do when providing assistance to the victim is to stop the effect of the damaging factor . If we are talking about a burn with boiling water, then it is necessary to remove (cut) the clothes soaked in hot liquid as soon as possible.

When exposed to a flame, it would be most correct to extinguish burning clothing with water, and then remove . If there is not enough water, extinguish should be done with improvised means – a dense cloth, sand, earth. In this case, do not cover the victim with his head – this can lead to inhalation of combustion products with subsequent burns of the respiratory tract and poisoning.

Do not shoot down the flames with your bare hands either, as this may cause the rescuer to become a victim himself. If the victim was in an enclosed area, remove to fresh air as soon as possible.

Clothes and shoes must be completely removed from the child , since in most cases we cannot reliably assess which parts of the body were exposed to high temperatures. It must be remembered that hair can also be damaged and behave like smoldering clothing, concentrating heat and burning the scalp, ears and face of the child.

Do not remove clothing adhering to the body , as there is a risk of further damage to the burned surface.

Never try to clean off adhered polymer!

In case of burns, rings, watches, bracelets, chains, beads should be removed immediately, since edema of the affected area will develop in the future, and these objects can squeeze tissues with impaired blood circulation until the development of tissue necrosis.

It is imperative to cool the affected area by immersion in cold water, snow.The duration of exposure to cold ranges from 3-5 to 15-20 minutes. It is not necessary to cool the burned area for too long, so as not to cause vasospasm with subsequent disturbance of blood circulation in the affected area. This measure is effective within 2 hours after receiving a burn and not only reduces pain, but also the depth of the lesion. Even when the effect of the damaging factor is terminated, the burn continues to develop and deepen due to the fact that the superficial layers of the skin play the role of a hot compress for the underlying ones. By cooling the surface of the body, this process can be interrupted.

In parallel with cooling, adequate pain relief is required. For this, pain relievers are used – Paracetamol or Analgin . Apply a clean, dry gauze bandage to the affected skin and show it to a doctor as soon as possible.

In case of deep burns, refrain from any manipulations. Do not try to independently clean the wound from adhering scraps of clothing and other contaminants (this manipulation can lead to exfoliation of large areas of skin, bleeding, and subsequently to infection of wounds), do not open the blisters on your own.A dry sterile bandage should be applied to the burn wound (for extensive burns, wrap the victim in a clean sheet), and then consult a doctor.

Oil ointments and other fat-containing products should not be used for burns. Such an action will only aggravate the severity of the injury, and the staff in the hospital will have to remove the oil film, causing additional suffering to the victim.

In case of any burns, an immediate doctor’s consultation is required!

Pediatric Gynecologist

Reproductive health is a state of complete physical, mental and social well-being, aimed at ensuring that a woman can independently conceive, bear and give birth to a healthy child.It is for the continuation of the human race that every girl comes into this world.

Unfortunately, the reproductive health of our girls has been deteriorating from generation to generation – a sick mother cannot give birth to a healthy child. the possibilities of the reproductive system depend on the girl’s intrauterine development (from the first days of pregnancy) and her further growth and development.

To help a girl grow up as a healthy and happy mother in the future, a gynecologist of childhood and adolescence is needed.

Children’s gynecologist is a doctor who diagnoses and treats diseases of the female genital area in girls.

When do they go to a pediatric gynecologist?

The first appointment with a gynecologist should take place in the first months after birth.

It is recommended to schedule the next examination at the age of 5-6 years – at this age, inflammatory processes of the reproductive system are often observed, which is associated with the failure of the immune system. If a girl complains of irritation, burning, itching, painful and frequent urination, parents need to rush to see a specialist.Another alarming signal at this age can be premature puberty, which is expressed in the growth of mammary glands and the beginning of hair growth. Such phenomena, as a rule, are associated with serious endocrine diseases that require urgent treatment.

The next visit to the gynecologist should be scheduled for 10-11 years. At this stage, it is important to make sure how correctly the female phenotype is formed – how secondary sexual characteristics begin to develop.

If by the age of 13-14 the girl does not show signs of puberty, parents should also show the child to a gynecologist so that he can help find out what is the reason for the delay in development.

With the onset of menstruation – at about 14-15 years old, the girl switches to a scheduled visit to the gynecologist every year.

Indications for unscheduled consultations can be: deviations in the anatomical structure of the genitals; delayed menstruation; irregular menstruation; itching and burning in the genital area and during urination; heavy menstrual bleeding; pain in the lower abdomen during menstruation; unpleasant discharge from the genital tract, combined with an increase in body temperature; genital trauma.

How should you prepare for your visit to a pediatric gynecologist?

Try to psychologically prepare the girl for this visit, do not focus your child’s attention on this consultation, she should feel calm and confident. The child needs to be explained that visiting a gynecologist is completely normal and necessary for every girl – after all, she is a future woman.

It is best if the girl comes for a consultation with her mother. Explain that no amount of manipulation in the pediatric gynecologist’s office can harm or hurt her.

What happens at a pediatric gynecologist’s appointment?

At the reception, the doctor will ask you about your complaints, talk to your mother about the course of pregnancy, complications in childbirth, visually examine the child, fill out an outpatient card.

At any age, even in the first months of a girl’s life, inflammatory diseases of the female genital organs are possible, in these cases the gynecologist will definitely take tests: smears for flora and degree of purity, bacterial culture, smears for sexually transmitted infections, general urine analysis and dr.

Conduct a manual examination on a gynecological chair through the rectum. If an examination of the vagina and cervix is ​​required, the pediatric gynecologist will use a pediatric vaginal speculum, which is carefully inserted through the opening in the hymen without damaging it. Inspection of both girls and girls is carried out only with their voluntary consent. During a visual examination, the gynecologist draws attention to the possibility of a certain type of deviation from the norm: physical development, the time of appearance and severity of secondary sexual characteristics, the development of the external genital organs, the time of the onset of menstruation and the nature of menstrual function are assessed.The information obtained is necessary to exclude a number of diseases (early or delayed sexual development, dysfunction of hormonal glands), the timely detection of which is the key to effective treatment.

Assess the condition of the bone apparatus. It has been proven that the correct structure of the bone pelvis is of great importance in the future for childbirth.

Skin condition: for acne, rashes and other skin manifestations associated with puberty.

Will also examine the mammary glands, i.e.because the incidence of benign dysplasia of the mammary glands has rejuvenated.

Talk to parents about proper hygienic care.

During conversations with older girls, the doctor will tell his young patients about the anatomical and physiological characteristics of their body, about the essence of menstruation, about hygiene during menstruation. will acquaint with the essence of reproductive function, talk about the dangers of early sexual activity, the dangers of abortion, the possibility of contracting sexually transmitted diseases (or sexually transmitted infections), justified symptoms and preventive measures for gynecological diseases.Will pay special attention to the role of physical activity in the proper formation of the body, to the daily routine and nutrition.

The girl will receive an answer to all her questions from a specialist, and not from random people, which will make her feel more comfortable in everyday life.

Will prescribe additional examinations, treatment, and, if necessary, give recommendations on contraception and lifestyle.

What additional examinations can a pediatric gynecologist prescribe?

  • Ultrasound examination (ultrasound) of the uterus and appendages
  • General and biochemical blood tests.
  • Analysis of urine.
  • Hormonal examination.
  • According to indications – consultation with related specialists
  • The need for certain examinations in each individual case is determined by the doctor.
  • After a full examination, the doctor gives the necessary recommendations with mandatory supervision.

Complications of female genital mutilation

Information is disaggregated by type if available.In general, the level of risk of complications increases with the severity of the intervention. Due to the limited nature of data on the various practices classified as Type IV, no information is provided on them.

Risk of immediate complications associated with types I, II and III

Acute pain: cutting off the nerve endings and sensitive tissues of the external genital organs causes severe pain. Adequate pain relievers are rarely used, and even if they are used, they do not always provide relief from pain. The wound healing period is also painful. Type III female genital mutilation is the most extensive procedure with a longer duration (15-20 minutes), which explains the increased severity and duration of the pain syndrome. The period of wound healing in this case is also longer and more painful. (1)

Shock may result from pain and / or bleeding. (2)

There are 90,058 cases of profuse bleeding (blood loss) and septic shock.(3)

Difficulty urinating , as well as obstructed feces may result from tissue swelling, edema and pain. (4)

Infection with infectious diseases can result from the use of an infected instrument (for example, when the same instrument is used to perform multiple female genital mutilation operations) and also occur during the wound healing period.(5)

Human Immunodeficiency Virus (HIV) : Using the same surgical instrument without sterilization may increase the risk of HIV transmission between girls undergoing surgery together (6). One of the studies revealed the presence of an indirect relationship between surgery and subsequent infection (7), but no direct relationship was found (8), possibly due to the low prevalence of the practice of using the same instrument for performing several operations, as well as the low prevalence of HIV among girls at the age at which this procedure is performed.

Death can result from blood loss or infections, including tetanus, or shock. (9)

Psychological Effects : Pain, shock and physical force used by the performers are among the reasons why many women consider female genital mutilation to be a traumatic event. (10)

Unexpected adhesion of the labia : Several studies have noted that in some cases, procedures that were originally intended to be type II can result in type III injury as a result of adhesion of the labia.(eleven)

Repetitive female genital mutilation appears to be quite common in cases of Type III mutilation. This is usually due to unsuccessful healing. (12)


1. Type I and II: El-Defrawi et al., 2001; Dare et al., 2004; Malmström, 2007. Type III: Boddy, 1989; Dirie and Lindmark, 1992; Chalmers and Hashi, 2000; Gruenbaum, 2001; Johansen, 2002
2. Type I and II: Egwuatu and Agugua, 1981; Agugua and Egwuatu, 1982.Type III: Dirie and Lindmark, 1992; Almroth et al., 2005a
3. Dirie and Lindmark, 1992; Jones et al. 1999; Chalmers and Hashi, 2000; Dare et al., 2004; Yoder et al., 2004
4. Type I and II: El-Defrawi et al., 2001; Dare et al., 2004; Yoder et al., 2004. Type III: Dirie and Lindmark, 1992; Chalmers and Hashi, 2000; Yoder et al., 2004; Almroth et al., 2005a
5. Dirie and Lindmark, 1992; Chalmers and Hashi, 2000; Almroth et al., 2005a, b
6. Klouman et al., 2005; Morison et al., 2001
7. Yount and Abraham, 2007
8. Morison et al., 2001; Okonofua et al., 2002; Klouman et al., 2005
9. Mohamud, 1991
10. Boddy, 1989; Johansen, 2002; Talle, 2007; Behrendt and Moritz, 2005; Malmström, 2007
11. Egwuatu and Agugua, 1981; Agugua and Egwuatu 1982; Dare et al., 2004; Behrent, 2005
12. Dirie and Lindmark, 1992; Chalmers and Hashi, 2000; Johansen, 2006b

Risk of long-term adverse health effects (occurring at any stage of life) associated with types I, II and III

Pain : Chronic pain can be caused by pinched or unprotected nerve endings.(13)

Infections : Over time, dermal cysts, abscesses and genital ulcers may develop with loss of superficial tissue (14). Chronic pelvic infections can lead to chronic back or pelvic pain (15). Urinary tract infections can rise and reach the kidneys, which can lead to kidney failure, septicemia, and death. It has been well established that there is an increased risk of recurrent urinary tract infections in both girls and women (16).

Keloid scar : Excessive growth of scar tissue at the incision site (17).

Reproductive tract infections and sexually transmitted infections : An increased incidence of some genital infections, including bacterial vaginosis, has been found (18). Some studies have found an increased risk of genital herpes, but no association with other sexually transmitted infections has been found (19).

Human Immunodeficiency Virus (HIV) : An increased risk of bleeding during intercourse, which often occurs when defibulation is required (type III), may increase the risk of HIV transmission. The increased prevalence of herpes in women who have undergone female genital mutilation may also increase the risk of contracting HIV, since genital herpes is a factor in HIV transmission.

Quality of Sexual Life : Removing or damaging highly sensitive genital tissues, especially the clitoris, can result in decreased sensitivity during intercourse and sexual problems such as decreased sexual satisfaction and pain during intercourse. Scars, pain and traumatic memories of the previous procedure can also cause similar problems (20).

Complications of childbirth : In addition to the risk of rupture and the need for an episiotomy, the risk of postnatal bleeding and the need for a caesarean section is seriously increased. The risk increases with the severity of female genital mutilation (21). Obstetric fistula is a complication associated with prolonged and obstructed labor and may be a side effect of complications caused by female genital mutilation (22).Research is ongoing to investigate the possible link between female genital mutilation and obstetric fistula.

Newborn risk : Newborns born to mothers with female genital mutilation have been found to have higher mortality rates and lower Apgar scores. At the same time, the severity of pathologies in newborns is in direct proportion to the severity of injuries received by their mothers (23).

Psychological Impact: Several studies have reported an increased likelihood of fear of intercourse, PTSD, anxiety, depression and memory loss. A woman’s awareness of the cultural significance of this practice does not guarantee the absence of psychological complications.


13. Akotionga et al., 2001; Okonofua et al., 2002; Fernandez-Aguilaret and Noel, 2003
fourteen.Egwautu and Agugua 1981; Dirie and Lindmark, 1992; Chalmers and Hashi, 2000; Rouzi et al., 2001; Okonofua et al., 2002; Thabet and Thabet, 2003
15. Rushwan, 1980; Klouman et al., 2005
16. Ismail 1999; Knight et al. 1999; Almroth et al., 2005a
17. Jones et al. 1999; Okonofua et al., 2002
18. Morison et al., 2001; Okonofua et al., 2002; Klouman et al., 2005; Elmusharaf et al., 2006b
19. Morison et al., 2001; Okonofua et al., 2002; Klouman et al., 2005; Elmusharaf et al., 2006b
20. Knight et al. 1999; Thabet and Thabet, 2003; El-Defrawi et al., 2001; Elnashar and Abdelhady 2007; Johansen, 2007
21. Vangen et al., 2002; WHO Study Group on Female Genital Mutilation and Obstetric Outcome, 2006
22. Tahzib 1983; Rushwan, 2000
23. Vangen et al., 2002; WHO Study Group on Female Genital Mutilation and Obstetric Outcome, 2006
24. Whitehorn, 2002; Behrendt and Moritz, 2005; Lockhat, 2006
25.Behrendt and Moritz, 2005; Lockhat, 2006; Nour et al., 2006; Elnashar and Abdelhady, 2007

Risk of additional complications associated with type III procedures

Subsequent surgeries : In case of previous infibulation, an incision must be made to widen the vaginal opening (defibulation) for sexual intercourse or childbirth. In some countries, it is common practice to re-narrow the vaginal opening (reinfibulation), which necessitates re-defibulation.There is evidence of re-narrowing of the vaginal opening in other cases (26).

Difficulty with menstruation and urination : Slow and painful menstrual bleeding and urination may result from almost complete stitching of the vagina and urethra (27). Hematocolpos may require surgery (28). Drip urine is a common occurrence in women who have undergone infibulation, which is probably associated with both difficult emptying of the bladder and stagnation of urine under a fold of scar tissue (29).

Pain during intercourse : Since infibulation requires opening the vaginal opening either surgically or directly by penetration during intercourse, intercourse is often painful in the first weeks after the onset of sexual intercourse (30). The male partner can also experience pain and complications (31).

Infertility : The link between female genital mutilation and infertility is mainly due to the removal of the labia majora: evidence suggests that the more tissue is removed during the procedure, the higher the risk of infection (32).


26. Berggren 2004, 2006; Nour et al., 2006
27. Akotionga et al., 2001; Knight et al. 1999; Almroth et al.,
2005a; Nour et al., 2006
28. Dirie and Lindmark, 1992
29. Egwautu and Agugua 1981; Agugua and Egwautu 1982; Dirie and Lindmark, 1992; Ismail 1999; Chalmers and Hashi, 2000; Njue and Askew, 2004