Vaginal lacerations from consensual intercourse in adolescents

Minimally invasive search for a missing vibrator

Objective

To report a unique surgical procedure that was utilized to locate a missing vibrator in the pelvis of a patient. Emergency room admissions and surgery secondary to the malfunctioning of devices intended for sexual stimulation are extremely common. Emergency room staff of hospitals in the United States usually are skilled in the detection and removal of these devices. Occasionally, surgical intervention is warranted if the device enters a cavity that cannot safely be explored in the emergency room setting. We report a case of a vibrator that was lost during sexual activity. A flat plate X-ray showed it to be in the abdominal cavity. Careful questioning of the patient revealed that the device had an unusually small diameter. Surgical intervention showed that the device ultimately ended up in the bladder without causing traumatic injury.

Methods

We created a narrated video to demonstrate the surgical procedure (Canadian Task Force Classification III).

Results

Laparoscopy and cystoscopy were used to visualize and successfully remove the device. The patient recovered uneventfully.

Conclusion

Following laparoscopic confirmation of the location of the device, it was removed via cystoscopy. This case demonstrates how background information, such as the size of the missing device in this case, can be critical to providing high quality patient care.

Traumatic Pneumoperitoneum After Vaginal Intercourse

OBJECTIVES

Pneumoperitoneum with peritonitis, although uncommon, is a serious injury encountered in the pediatric emergency department. Although the patients may often appear ill or toxic, they can have normal vital signs at initial presentation. Patients with such injury can present with a variety of complaints because of the nature of referred pain. As a result, some patients may be more or less straightforward, thus illustrating the importance of obtaining a detailed history and performing a thorough physical examination.

METHODS

We discuss an uncommon case report of pneumoperitoneum with peritonitis in an adolescent patient presenting with vaginal bleeding and abdominal pain hours after vigorous coitus.

RESULTS

Examination under anesthesia, flexible sigmoidoscopy, and exploratory laparoscopy revealed a vaginal laceration and a 2- to 3-cm perforated area at the left edge of the vaginal laceration that involved the rectovaginal septum entering the peritoneal cavity.

CONCLUSIONS

Pneumoperitoneum resulting from vaginal intercourse in an otherwise healthy adolescent female is a rare cause of peritonitis. Although it has been described in the adult literature, this case illustrates the importance of considering sexual history as a contributory factor in pediatric patients presenting with an acute abdomen.

Unusual Case of a Missing Vibrator Device in the Pelvis

Emergency room admissions and surgery secondary to the malfunctioning of devices intended for sexual stimulation are extremely common. Emergency room staff in the United States are commonly skilled in the detection and removal of some of these frequent occurrences. Occasionally, surgical intervention can be warranted if the device enters a cavity that cannot safely be explored in the emergency room setting. We report a case of a vibrator which was lost during sexual activity and appeared on flat plate X-ray to be in the abdominal cavity. A careful history showed that the device was of an unusually narrow diameter, and surgical intervention showed the device ultimately ended up in the bladder without traumatic injury. Following laparoscopic confirmation of the device's location in the bladder, cystoscopic removal was performed and the patient recovered uneventfully.

Vaginal postcoital injuries requiring surgical intervention: a case series and literature review

This case series describes clinical features and management of women who required surgical repair of vaginal injuries following consensual intercourse in our institution during the last decade. As a secondary aim, we reviewed the literature on the topic. We searched our institution's database for procedures coded as "Suture of Vagina," excluding trauma not related to consensual sexual activity: between January 2008 and December 2017, 20 women underwent hemostatic suturing for vaginal injuries following intercourse. Mean age was 27.6 ± 12.5 (range, 16-63) years, 5 (25%) women were parous, 13 (65%) women used no contraception, and 1 (5%) used birth control pills. Three patients (15%) were postmenopausal. Eight injuries (40%) occurred following first-time intercourse, two (10%) occurred after intercourse with a new partner. Median time from bleeding onset to admission was 12 (range, 2-24) h. One patient (5%) was hemodynamically unstable and required treatment with packed cells. Median time from admission to surgery was 56 (range, 15-540) min. The laceration site was identified at the vaginal fornix in nine (45%) patients, at mid-vagina in four (20%), at the hymenal ring, or the posterior fourchette in six (30%). Tear of a longitudinal vaginal septum was identified in one patient (5%). To conclude, vaginal postcoital injuries are a rare occurrence, nevertheless they may involve significant blood loss and therefore require prompt evaluation and treatment. Once the patient is hemodynamically stable, psychosexual assessment and support should be offered to the patient and her partner.

[Postcoital bleeding: 68 case-reports and review of the literature]

L'acte sexuel consenti ou imposé, peut être à l'origine des traumatismes. L'hémorragie post coïtale est un symptôme gynécologique commun. Elle peut révéler de sérieux problèmes. Le but de notre travail est d’étudier le profil épidémiologique, diagnostique et thérapeutique ainsi que les moyens préventifs en cas de déchirure post coïtale. Il s'agit d'une étude prospective, étalée sur deux ans, mené au service de gynécologie obstétrique du CHU Med VI de Marrakech. Nous avons colligé 68 patientes. L’âge moyen est de 27 ans, la majorité des patientes étaient des nullipares soit 89,7% des cas. La moitié des patientes avaient un mariage traditionnel. Le rapport était consentent dans 74% des cas. L'hémorragie génitale a constitue le motif de consultation le plus fréquent soit 98% des cas. Les lésions hyménales ont été retrouvées dans 39% des cas et la lésion siégeait dans le cul de sac postérieur chez 35% des cas. La prise en charge thérapeutique a consisté en une suture chirurgicale chez 97% des cas, associé à une transfusion sanguine chez deux patientes et une abstinence sexuelle pendant minimum deux semaines chez toutes nous patientes. Le contexte social ainsi que le manque d’éducation sexuelle sont souvent incriminé d'où l'intérêt d'une prise en charge psychologique pour prévenir aussi bien le retentissement du traumatisme sur la sexualité que les récidives.

Retrospective Analysis of Clinical Features, Treatment and Outcome of Coital Injuries of the Female Genital Tract Consecutive to Consensual Sexual Intercourse in the Limbe Regional Hospital

Introduction

Nonobstetrical genital injuries are gradually becoming a common cause of genital injuries. Consensual sex has been reported to be a possible cause of this type of injuries, but its contribution to traumatic lesions of the female genital tract is not well known. It has been suggested that injury consecutive to consensual sex can be extensive and life‐threatening.

Aim

The aim of this study was to analyze the clinical features, treatment modalities, and the outcome of injuries to the female genital tract consecutive to a consensual sexual intercourse.

Methods

A retrospective review of records of female patients admitted in our institution with a complaint of genital injury over a 5‐year period. We collected data regarding patient and injury characteristics, findings of the gynecologic examination, modalities of management and final outcome.

Main Outcome Measures

Anatomic location and nature of injury, modalities of management, admission rate and mortality rate.

Results

Forty six cases could be analyzed. Their mean age was 25.6 years. Almost 35% of patients sustained the injury during their first sexual contact. The majority presented with bleeding, often combined with pain. One patient presented with features of peritonitis. During examination, no anatomic lesions could be identified in 16 (34.8%) of patients. When a lesion was present, it concerned mostly the posterior fornix (28.3%) and the lateral vaginal wall (10%). The most frequently described lesion was a laceration. The majority of patients (83%) were treated with suturing under local anesthesia. The admission rate was 28%, and was significantly higher in patients with a laceration of the posterior fornix. No death was recorded.

Conclusions

Coital injuries following consensual sex often present in the form of a life‐threatening condition and young female with no previous sexual experience are particularly exposed. Most lesions can be treated with a simple suture. TchounzouRandChichom‐MefireA. Retrospective analysis of clinical features, treatment and outcome of coital injuries of the female genital tract consecutive to consensual sexual intercourse in theLimbeRegionalHospital.SexMed 2015;3:256–260.

Consensual intercourse resulting in an extensive rectovaginal tear: an extremely rare occurrence

INTRODUCTION

Rectovaginal tears are usually associated with the insertion of foreign bodies, accidental trauma, and nonconsensual intercourse.

AIM

The aim of this study was to describe an extremely rare case of extensive rectovaginal tear as a result of consensual vaginal and anal intercourse.

METHODS

A case is presented along with review of the literature.

RESULTS

A 20-year-old woman presented with acute perineal pain and minor vaginal bleeding following consensual vaginal and anal intercourse. No insertion of sex toy or any other object was reported. Vaginal and rectal examination revealed a ruptured posterior vaginal wall with wide communication with the rectum, without involvement of the anal sphincters. Surgical treatment with primary repair of the tear and diverting colostomy was performed.

CONCLUSIONS

Although consensual intercourse is usually associated with minor genital trauma, rare but potentially serious injuries can occur. Clinicians should be aware of the possibility of such injuries because failure to identify them can lead to delayed treatment and poor outcome.

[Sex-related injuries]

OBJECTIVE

To describe the injuries occurring during consensual or not sexual intercourses, or during particular sexual practices and their medical, surgical and forensic care.

METHODS

We reviewed the literature using PubMed database to clarify the diagnostic and therapeutic approach of: (1) in men: fracture of the corpora cavernosa, penile and urethral foreign bodies (piercing, rings) as well as amputation of penis; (2) in women: trauma during consensual or not sexual intercourses.

RESULTS

In men, the most common pathology is the rupture of the tunica albuginea of the corpora cavernosa on the erect penis. The diversity of sexual practices, however, exposes urologists to meet trauma less ordinary: strangulation of the penis by rings, genital piercing complications or introduction of foreign bodies into the urethra or under the skin. Less common are traumatic amputations of the penis. In women, sexual trauma are often benign in their clinical presentation but generally occur in the context of sexual violence and require psychological support, forensic and prevention of sexually transmitted infections.

CONCLUSION

The literature is mainly based on expert opinion and single-center retrospective series. We summarized for each situation epidemiology, diagnosis and treatment.

Critical obstetric and gynecologic procedures in the emergency department

Obstetric and gynecologic emergencies are common reasons for emergency department visits. Therefore, emergency physicians must be proficient in the management and treatment of these emergencies. This article reviews critical procedures and provides an overview of each procedure and the indications, contraindications, technique, and potential complications.