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Kurakula S, Nallur Siddaraju M, Kumarswamy V, Raza QUA, Kompella AR. Non-Obstetric Traumatic Vulvar Hematoma Managed in a Low-Resource Setting: A Case Report of a Rare Condition. Cureus 2023; 15:e40369. [PMID: 37456375 PMCID: PMC10340129 DOI: 10.7759/cureus.40369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Most cases of vulvar hematomas are caused by either genital tract injury during childbirth or trauma. Although uncommon, instances of spontaneous vulvar hematomas occurring without trauma or unusual sexual practices have been reported. In this report, we present the case of a 24-year-old woman who experienced an injury after a fall, resulting in a rapidly enlarging vulvar hematoma. Due to the worsening pain and swelling, surgical intervention was undertaken for her management.
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Affiliation(s)
- Sowjanya Kurakula
- Obstetrics and Gynecology, Mamta Institute of Medical Sciences, Khammam, IND
- Obstetrics and Gynecology, Sekgoma Memorial Hospital, Serowe, BWA
- Obstetrics and Gynecology, Nyangabgwe Referral Hospital, Francistown, BWA
- Obstetrics and Gynecology, Gandhi Medical College, Musheerabad, IND
| | | | - Varalakshmi Kumarswamy
- Obstetrics and Gynecology, RajaRajeshwari Medical College, Bangalore, IND
- Obstetrics and Gynecology, M.S Ramaiah Medical College, Bangalore, IND
- Obstetrics and Gynecology, RNT Medical Hospital, Udaipur, IND
| | - Qurat Ul Ain Raza
- Internal Medicine, RAK Medical & Health Sciences University, Ras al Khaimah, ARE
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Liu R, Armstrong E, Constable S, Buchanan LB, Mohammadi A, Galiwango RM, Huibner S, Perry MC, Prodger JL, Coburn B, Kaul R. Soluble E-cadherin: A marker of genital epithelial disruption. Am J Reprod Immunol 2023; 89:e13674. [PMID: 36593681 DOI: 10.1111/aji.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
PROBLEM The genital epithelial barrier is a crucial first line of defence against HIV, and epithelial disruption may enhance HIV susceptibility. Assessment of genital epithelial integrity requires biopsies, but their collection is not practical in many research settings. A validated biomarker of genital epithelial barrier integrity would therefore be useful. The purpose of this study was to evaluate soluble E-cadherin (sE-cad) as a marker of genital epithelial disruption. METHOD OF STUDY Using in vitro models of endocervical and foreskin epithelial cells, we assessed changes in sE-cad, IL-6, IL-1β, and IL-1α levels following mechanical disruption. We also assessed changes in sE-cad levels in vivo in cervicovaginal secretions after epithelial disruption by endocervical cytobrush sampling in Canadian women, and assessed the relationship between levels of sE-cad in coronal sulcus swabs to membrane-bound E-cadherin in the overlying foreskin tissue in Ugandan men. RESULTS sE-cad levels immediately increased after in vitro epithelial physical disruption with the degree of elevation dependent on the extent of disruption, as did levels of IL-1β and IL-1α; this was followed by a delayed increase in IL-6 levels. In vivo results confirmed that sE-cad levels in cervicovaginal secretions were elevated 6 h after cytobrush sampling when compared to baseline. Furthermore, levels of sE-cad in the prepuce were inversely correlated with the amount of membrane-bound E-cadherin of overlying tissue. CONCLUSION Our results validate the use of sE-cad as a marker of epithelial disruption and demonstrate that the processes of physical disruption and inflammation in the genital tract are strongly intertwined.
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Affiliation(s)
- Rachel Liu
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Armstrong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shirley Constable
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lane B Buchanan
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Avid Mohammadi
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Sanja Huibner
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marie C Perry
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Jessica L Prodger
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bryan Coburn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Traumatic rectovaginal fistula after sexual intercourse following a non-consensual anal penetration: a case report and a review of the literature. Forensic Sci Med Pathol 2021; 17:679-683. [PMID: 34677792 DOI: 10.1007/s12024-021-00409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Rectovaginal fistulas are rare genital lesions, often due to obstetric causes. More rarely they are a consequence of sexual intercourse. We present the case of a 36-year-old woman who presented to a gynecological emergency department with pelvic pain and feces coming from the vagina. This symptomatology appeared after non-consensual anal intercourse following consensual penile vaginal penetration. She was treated for a perforation of the rectovaginal septum. On the basis of our results, we reviewed the cases published in the literature, with a summary of the elements that may favor the appearance of this lesion, such as "virginity", obstetrics and gynecological history, or coitus position, its classification by size and localization, and the therapeutic indications (suture repair of the wall or a colostomy). Better knowledge of this type of lesion would improve the practice of forensic pathologists for screening and management.
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Female genital injury-which findings have to be considered physiological using colposcopy with and without toluidine blue dye? Forensic Sci Med Pathol 2021; 17:634-642. [PMID: 34613594 PMCID: PMC8629788 DOI: 10.1007/s12024-021-00417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
Abstract
This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.
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[Cutaneous and mucosal manifestations of sexual practices]. Ann Dermatol Venereol 2020; 147:629-636. [PMID: 32654793 DOI: 10.1016/j.annder.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
Sexual activity may on occasion be associated with local trauma, infections or allergies. During visits, patients may be reluctant to report on the circumstances leading to such lesions. The dermatologist may be unfamiliar with these manifestations, especially where they occur outside the genital area. Our aim is to present the spectrum of genital and extra-genital signs associated with sexuality. The dermatologist must feel sufficiently confident to broach the patient's sexual history in order to avoid any diagnostic errors and unnecessary explorations.
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Lincoln CA. Sexual Assault: Forensic Examination in the Living and Deceased. Acad Forensic Pathol 2019; 8:912-923. [PMID: 31240080 DOI: 10.1177/1925362118821490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/22/2018] [Indexed: 11/16/2022]
Abstract
The forensic examination of a person suspected of having been sexually assaulted encapsulates the breadth of forensic medicine possibly more completely than any other situation in forensic practice. Whether in the living or deceased, detection of injury and biological material to support or exclude sexual activity requires a careful, methodical approach to ensure robust evidentiary value and an understanding of genito-anal anatomy and sexual physiology to interpret its significance for the courts. This paper is not intended as an exhaustive guideline but aims to provide a general overview of the key components of forensic sexual assault examination highlighting the common and different aspects in living and deceased persons.
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Lapresa Alcalde MV, Hernández Hernández E, Bustillo Alfonso S, Doyague Sánchez MJ. Non-obstetric traumatic vulvar hematoma: Conservative or surgical approach? A case report. Case Rep Womens Health 2019; 22:e00109. [PMID: 30976525 PMCID: PMC6441764 DOI: 10.1016/j.crwh.2019.e00109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/14/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
Non-obstetric vulvar hematomas are rare and few cases have been reported in the literature. There are no clinical guidelines for their management. In most cases they can be treated conservatively but in some cases surgical intervention will be necessary. We present the case of a patient with a traumatic vulvar hematoma who required surgical treatment; we also review the literature on this gynecological pathology. Our case highlights the importance of early surgical intervention to reduce associated morbidity and to minimize hospital stay. Most traumatic vulvar hematomas are small and can be managed conservatively. Non-obstetric genital hematomas can reach a volume that may cause hemodynamic instability. Vulvar hematomas more than 4 cm across may cause necrosis and require surgical assessment. If surgical intervention is necessary, all the blood clots must be removed without excessive manipulation. Surgical intervention is necessary if the hematoma is expanding, of if there is hemodynamic instability or persistent pain.
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Nguyen GH, Lang N, Lautenschlager S. Nympho-hymenal tear: a distinctive entity? J Eur Acad Dermatol Venereol 2016; 31:e293-e294. [PMID: 27896881 DOI: 10.1111/jdv.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G H Nguyen
- Department of Dermatology, University of Colorado Anschutz Medical College, Aurora, Colorado, 80045, USA
| | - N Lang
- Private practice, Kohlrainstrasse, 10, 8700 Küsnacht, Switzerland
| | - S Lautenschlager
- Outpatient Clinic of Dermatology & Venereology, Triemli Hospital, Zürich, 8004, Switzerland
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