Case Series: Vaginal Rupture Injuries after Sexual Assault in Children and Adolescents

Sexual abuse of children - some recommendations from a forensic gynaecologist's expert experience

Prompt and better primary examination of victims accompanied by meticulous note-taking in cases of suspected child sexual abuse are needed to improve both conviction rates and to avoid inappropriate criminal investigations and proceedings. The majority of child sexual abuse victims are female. More training is needed for gyaecologists in this field.

A Laparoscopic Approach to Postcoital Vaginal Perforation in an Adolescent with Peritonitis and Hypovolemic Shock

BACKGROUND

Vaginal laceration during coitus is not a rare occurrence; however, vaginal perforation from coitus is uncommon and occurs in less than 1% of nonobstetric genital tract injuries. Limited case reports exist discussing the recognition and management of vaginal perforation. Previously described management is commonly performed with laparotomy.

CASE

We report a case of postcoital vaginal laceration and posterior fornix perforation in an adolescent with hemoperitoneum, pneumoperitoneum, and subsequent hypovolemic shock, and describe a laparoscopic approach for repair.

SUMMARY AND CONCLUSION

Vaginal perforation with subsequent peritonitis and hemodynamic instability is a rare outcome in an adolescent who presents to the emergency department with pain or bleeding in the setting of recent penile intercourse. Delays in recognition can lead to further patient compromise, with potential morbidity or mortality. In this patient cohort, we suggest maintaining a high clinical suspicion for this sequela, and a low threshold for surgery with perforations greater than 1 cm. In the event that surgical management is warranted, we recommend a laparoscopic approach to increase visibility and to improve postoperative outcomes.

Genital injuries acute evaluation and management

Genital trauma may result in external injuries to the labia, vulva or vagina, urethra and anus and internal injuries to the bony pelvis, bladder, bowels and reproductive organs. Worldwide, the most common cause of genital trauma in reproductive age women is injury sustained during childbirth, but in this chapter we will focus on accidental genital injuries as well as those arising from sexual violence, and female genital mutilation. While genital injuries alone rarely result in death; if not properly managed, chronic discomfort, dyspareunia, infertility, or fistula formation may result. Clinicians need to be able to recognize these injuries and provide initial management, and assure that the patient's mental, emotional and physical needs are addressed.