Consensual Coital Lacerations: A Case Series

Abstract

Consensual coital lacerations are commonly encountered in clinical practice. Though not as common as lacerations sustained during childbirth, they account for significant morbidity among sexually active women. Consensual sexual intercourse should ordinarily not cause pain as 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 threatening blood loss. The authors report their experience with treating patients with coital laceration. The mechanism of injury and treatment modality were also highlighted. Three cases are presented. The first patient bled profusely from the laceration and went into shock due to severity of bleeding. The second case presentation was similar to the first only that she was haemodynamically stable at presentation without any sign of shock. The last case was a newlywed who was having sexual intercourse for the very first time. All three patients were not adequately lubricated prior to penetration due to inadequate foreplay. All three cases were consensual and were either with the lover as in the first two cases or the spouse as in the third case. None of them was circumcised or had had any form of genital mutilation. The case series bring to fore the common mechanism of consensual coital laceration, the need for clinicians to have high index of suspicion when reviewing susceptible patients as well as proper and prompt management of the condition which may require surgical repair as was in all the cases highlighted.

Non-Obstetrics Vaginal Lacerations from Consensual Coitus: A Case Series

“…Non-obstetric laceration of the vaginal wall following introitus is a usual occurrence, though under-reported in our environment, particularly during coitarche [1,5]. It can vary from minor selflimiting minimal vaginal bleeding, which do not require medical attention to life threatening tear with severe bleeding which could progress to haemorrhagic shock and death if not promptly managed [1][2][3]. This was the situation in our first, second and fifth cases.…”

“…Prompt and proper management of this condition is important to prevent complications such as haemorrhage, sepsis, vaginal stenosis, injury to abdomino-pelvic organs, recto-vaginal fistula, vesico-vaginal fistula and death from occurring [3,10]. A rectal examination must be performed in all cases of coital injuries on the posterior vaginal wall to rule out rectal involvement.…”

“…This severe bleeding could progress to haemorrhagic shock and death if not promptly managed. Consensual coital injuries are not uncommon in gynaecological practice, yet available data are relatively scarce [1][2][3].…”

“…Complaints regarding coital injuries could also be perceived as shameful as a result of cultural stigmatization associated with sex related issues in our environment [1,2]. Consensual coital injuries are most likely underreported especially when the injury is minor [3]. However, some of the major and life threatening consensual coital injuries do present to the hospital for care, but early diagnosis and prompt management may be challenging due to cultural factors and limited experiences by care givers [2,3].…”

“…Consensual coital injuries are most likely underreported especially when the injury is minor [3]. However, some of the major and life threatening consensual coital injuries do present to the hospital for care, but early diagnosis and prompt management may be challenging due to cultural factors and limited experiences by care givers [2,3]. The true incidences of consensual coital injuries are difficult to ascertain, especially because the nature of vaginal injury usually remains undisclosed [2].…”