Postcoital Vaginal Perforation and Evisceration in Women with No Prior Pelvic Surgery: Laparoscopic Management and Systematic Review of the Literature

Abstract

Objective: to evaluate risk factors, causes, management and surgical therapy of postcoital vaginal perforation and evisceration in women with no prior pelvic surgery. Data sources: We used MEDLINE (PubMed), Scopus, Embase and Web of Science for our research. Our review includes all reports from 1980 to November 2020. The research strategy adopted included different combinations of the following terms: (intercourse) AND (coitus) AND (vaginal perforation). Methods of study selection: we report a case of vaginal evisceration after consensual intercourse in a young and healthy woman. In addition, we performed a systematic review of vaginal perforations with or without evisceration in women without prior surgery or any other predisposing disease. All studies identified were listed by citation, title, authors and abstract. Duplicates were identified by an independent manual screening, performed by one researcher and then removed. For the eligibility process, two authors independently screened the title and abstracts of all non-duplicated papers and excluded those not pertinent to the topic. Tabulation, integration and results: We have followed the PRISMA guidelines. Five manuscripts were detected through the references of the works that had been identified with the research on MEDLINE (PubMed), Scopus, Embase and Web of Science. We found 16 cases between 1980 and 2020. The young age and the virginal status represent the principal risk factors and all the lacerations occurred in the posterior vaginal fornix. The most common surgical technique was the laparotomic approach and, in the remaining cases, the laparoscopic and vaginal route was performed. Conclusions: Post-coital vaginal perforation and evisceration in women with no prior pelvic surgery is a rare condition in the clinical practice and, when it is associated with evisceration it is a surgical emergency. Usually, these injuries are not life-threatening conditions but, a delay in diagnosis, can lead to severe complications. In consideration of the high heterogeneity of the data in the literature, it is essential to define a diagnostic–therapeutic management for the patients with vaginal perforation. With our review, we try to identify the associated risk factors, the best and fastest diagnosis, and the best surgical approach. We believe that a combined vaginal and laparoscopic approach can be the best surgical treatment, useful to diagnose injuries of the abdominal organs and to improve postoperative outcome.

Vaginal injuries after consensual sexual intercourse — a survey among office-based gynecologists in Hamburg, Germany

“…Due to the retrospective nature of data collection intentionally not reflecting single cases and case details and due to the forensic background of our study, the questionnaire reflected on the maximum severity of observed injuries instead of detailed anatomical injury location, a dimension that was not addressed in previously published studies. Although the present results do not allow conclusions to be drawn about the absolute frequency of mucosa penetrating injuries and penetrating injuries of the vagina, they do show that penetrating injuries, although less frequent than milder types of injuries, should not be regarded as isolated cases, as they have been sporadically described in the literature to date [ 39 – 42 ] since more than 14% of the physicians surveyed reported having already diagnosed such injuries. Memory bias must be considered, as more severe injuries are usually better remembered than nonspecific, superficial lesions.…”

Alternative Insertion Site of Nexplanon: Description of a Case Report and Systematic Review of the Literature

“…Discrepancies were resolved by consensus. Two manuscripts were detected through the references of the works that had been identified with the research on PubMed, Scopus and Google Scholar [ 7 ].…”

Induced Dryness Stress on Human Vaginal Epithelium: The Efficacy of a New Vaginal Gel

“…The modifications of the vulvovaginal district are common and can be found in at least 50% of menopausal women [1][2][3][4][5]. In VVA there can be found many signs and the most common include dryness, redness, itching, pain at intercourse, and occasionally discharge or bleeding [6,7] Until now and for the past decades, the therapy mostly employed for the management of VVA and vaginal dryness in post menopausal women has been either systemic or with local low-dose estrogen therapy [8][9][10][11] Because of the chronic nature of VVA and genitourinary syndrome of menopause (GSM), treatments are recommended to be prescribed at the onset of the symptoms and signs of atrophic changes of the vagina in order to avoid the development of severe pictures of the condition, and should be continued over time so as to maintain their benefits [12]. The therapy needs to be targeted and personalized, taking into account the preferences of women.…”