Case Report

iMedPub Journals Gynecology & Obstetrics Case Report 2017

http://www.imedpub.com/ Vol.3 No.1:41
ISSN 2471-8165
DOI: 10.21767/2471-8165.1000041

Consensual Coital Lacerations: A Case Series

Oseni TIA*, Fuh NF and Eromon PE
Department of Family Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
*Correspondingauthor: Oseni TIA, Department of Family Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria, Tel:
+2348036281897; E-mail: [email protected]
Received date: 21 October, 2016; Accepted date: 20 February, 2017; Published date: 22 February, 2017
Citation: Oseni TIA, Fuh NF, Eromon PE. Consensual Coital Lacerations: A Case Series, Gynecol Obstet Case Rep. 2017, 3:1.

Case Series
Abstract Presented are three patients with consensual coital vaginal
lacerations who were managed by the authors. They all had
Consensual coital lacerations are commonly encountered severe vaginal injury associated with profuse bleeding. One of
in clinical practice. Though not as common as lacerations the patients came with hypovolaemic shock. None of them
sustained during childbirth, they account for significant was circumcised or had any form of genital mutilation. Their
morbidity among sexually active women. Consensual presentation and management is discussed below after
sexual intercourse should ordinarily not cause pain as
obtaining approval from the ethics committee.
opposed to rape. It commonly results from inadequate
foreplay prior to penetration leading to non-lubrication of
the vagina. Severe coital laceration may lead to life Case 1
threatening blood loss. The authors report their
A 25 year old P0+0 single lady who had a deep transverse
experience with treating patients with coital laceration.
laceration about 4cm on the posterior fornix of the vagina. She
The mechanism of injury and treatment modality were
also had multiple superficial vaginal lacerations with a 1.5 cm
also highlighted. Three cases are presented. The first
patient bled profusely from the laceration and went into
laceration at the introitus on the inner lip of the right labia
shock due to severity of bleeding. The second case minora and a 1cm laceration on the left lateral mid vaginal
presentation was similar to the first only that she was wall. She presented two hours after onset of bleeding and had
haemodynamically stable at presentation without any hypovolaemic shock on initial assessment. She sustained the
sign of shock. The last case was a newlywed who was injuries on having sex with her fiancé who has been away for
having sexual intercourse for the very first time. All three three months. There was no adequate foreplay prior to
patients were not adequately lubricated prior to penetration.
penetration due to inadequate foreplay. All three cases
were consensual and were either with the lover as in the Case 2
first two cases or the spouse as in the third case. None of
them was circumcised or had had any form of genital A 25 year old P0+1 single lady who had a deep longitudinal
mutilation. The case series bring to fore the common laceration on the posterior fornix of the vagina extending to
mechanism of consensual coital laceration, the need for the perineum. She presented to the hospital twelve hours
clinicians to have high index of suspicion when reviewing after onset of vaginal bleeding. She has not had sex for three
susceptible patients as well as proper and prompt years and was having sex with her new boyfriend for the first
management of the condition which may require surgical time. Foreplay was not adequate and she was not properly
repair as was in all the cases highlighted. lubricated.

Keywords: Consensual; Coital; Laceration; Penetration Case 3

A 27 year old P0+0 newly wed who had a deep laceration
about 2 cm on the left posterior-lateral wall of the vaginal
Introduction introitus. She presented three days after onset of bleeding.
Coital lacerations are common in our environment, though She was having sex for the very first time and thought the
under-reported [1-3]. They vary from minor self-limiting bleeding was from the hymen and only presented when it
vaginal injury with minimal bleeding, which do not require persisted. There was no adequate foreplay as it was also the
medical attention to life threatening tear with severe bleeding first time the husband was having sex.
which could progress to haemorrhagic shock and death if not
promptly managed [3-5].

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 Gynecology & Obstetrics Case Report 2017
ISSN 2471-8165 Vol.3 No.1:41

Treatment sepsis, vaginal stenosis, injury to abdomino-pelvic organs,

recto-vaginal fistula, vesico-vaginal fistula and death from
The first patient required aggressive fluid resuscitation to occurring. A rectal examination must be performed in all cases
reverse the shock. All the patients were promptly taken to the of coital injuries on the posterior vaginal wall to rule out rectal
theatre where they had examination under general involvement leading to rectovaginal fistula. A differential
anaesthesia. The lacerations were repaired primarily with diagnosis of severe upper vaginal injury should be kept in mind
continuous interlocking chromic catgut 0 sutures and in females who present with an acute abdomen with or
haemostasis secured. All the patients had digital rectal without vaginal bleeding following coitus [3]. Management
examination to ensure that the rectal mucosa was not involved include resuscitation with intravenous fluid, transfusion in
in the laceration as well as ensure that the rectum was suture severe blood loss and surgical repair of the laceration. Sex
free. The packed cell volume for all the patients both pre and education and counselling is essential in preventing this
post operatively was adequate. None of the patients was condition from happening or recurring and should be
transfused though they were all placed on haematinics. The incorporated in management. Patient and her partner were
bladder and urethra were also examined to rule out urinary counselled on the importance of negotiating sex and having
tract injury. They were all discharged within forty eight hours adequate foreplay as well as correct use of contraceptive.
and there were no perioperative complications. In conclusion, Coital injury, though commonly encountered
and mild, could be life threatening. Most cases result from
Discussion rough and hurried coitus leading to functional peno-vaginal
disproportion. It is thus preventable in most cases. The Family
Consensual coital vaginal injury is a usual occurrence, Physician should be able to promptly and properly diagnose
though under-reported in our environment, particularly during and manage coital injuries when they present. Efforts at
coitarche [1-3]. It can vary from minor self-limiting minimal prevention including appropriate counselling and sex
vaginal bleeding, which do not require medical attention to life education should form part of our routine practice.
threatening tear with severe bleeding which could progress to
haemorrhagic shock and death if not promptly managed [3-5].
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