Post-coital vaginal lacerations
IT is not uncommon for women to experience some amount of superficial trauma or tears to the vagina especially after a lengthy session of intercourse. However, at times, the trauma to the vagina can be quite extensive, requiring emergency intervention. Dr Daryl Daley is a medical officer in obstetrics and gynaecology at May Pen Hospital, and consultant OBGYN at Gynae Associates, 23 Tangerine Place, Kingston 10, and Shops 46-50, Portmore Town Centre, St Catherine. Telephone him at 929-5038/9 and 939-2859 or e-mail drdaryldaley@gmail.com.
Women with extensive vaginal lacerations usually present with continuous bright red blood from the vagina following sexual intercourse. It is usually painless. If the woman loses a large amount of blood, she may show signs of weakness, have shortness of breath, and palpitations. When evaluating women with reports of bleeding following intercourse, the physician should have a high index of suspicion for sexual assault and take a thorough history and perform a careful physical examination.
Risk factors for post-coital vaginal lacerations include:
* Nonconsensual or forceful consensual intercourse
* Vigorous sexual activity (“daggering”)
* The use of foreign objects or sex toys
* First coitus
* Hypoestrogenic states (menopause, lactation)
* Pelvic fractures/abnormalities
* History of radiotherapy
* Large male phallus
* Sexual positioning with the woman lying on her back and thighs being hyperflexed, and certain sitting positions are associated with lacerations.
The most common sites of vaginal lacerations are the back of the vagina (posterior fornix) and the vaginal walls.
The majority of these cases require general anaesthesia in the operating theatre for proper evaluation. This allows the vaginal tissue to be more relaxed so that the area can be examined properly. Usually, once the laceration is identified, it can easily be repaired with sutures (stitches) and the bleeding stops immediately. Other organs such as the bladder and the urethra are examined to ensure they are not damaged as they are in close proximity to the vagina. In rare cases, the laceration in the posterior fornix can cause a communication with the abdomen and may involve the bowel.
Pelvic rest for six weeks is appropriately recommended in order to allow healing of the tissues. Studies suggest that women who suffer trauma of the genital tract are more likely to suffer dyspareunia (painful sex), sexual dysfunction, and chronic pain of the lower genital tract and pelvis. The physician should therefore ensure adequate follow-up of these patients in order to identify and administer early treatment of these complications.