Consensual coital laceration of the posterior vaginal fornix with hemorrhagic shock in a teenage girl: Diagnostic and management challenges.

Abstract

INTRODUCTION

Life threatening injuries can result from consensual
coitus. In most parts of Africa where children are
raised without adequate sex education, and sex is
seen as shameful topic and taboo in extreme cases,
coital injuries are unlikely to be reported or may be
misdiagnosed and mismanaged. This may result in
morbidities and mortalities. Scarcity of data on this
subject underscores the need for this case report to
create awareness and add to the body of knowledge.
Case report: Patient was 17-year old student who
presented with hemorrhagic shock to the emergency
unit of a reference hospital in Southern Nigeria with a
4 hour history of torrential vaginal bleeding and 2
fainting episodes following consensual coitus. History
was misleading as patient, initially, denied any
history of sexual activity. However, with a more
tactful and empathic approach, the patient admitted
having consensual coitus prior to symptoms. On
examination, she was found to have sustained
lacerations of the posterior vaginal fornix. She was
promptly resuscitated and a repair under anesthesia
was done in the theatre. She was transfused with 2
units of blood and discharged in good condition after
48 hours on admission.

CONCLUSION
Consensual coital injuries could be life threatening,
yet may be misdiagnosed and poorly managed due to
shame and stigma associated with it in our
environment. Lack of awareness, low index of
suspicion, poor approach to history and management
could lead to poor outcome. High index of suspicion,
tact, privacy, empathy, good clinical judgment and
multidisciplinary approach to care are essential to
early diagnosis and good management of coital
injuries.