COITAL INJURIES

(A revi~w of 10 cases)

by

S. PREM CHANDRA,* F.R.C.S. (Eng. & Edin.), D.R.C.O.G. (Lond.) and SusHILA DEVI RATHEE, * M.B.B.S.

Injuries to the female genitalia may Increased friability of tissue in pre­ occur during . gnancy and post-partum period pre­ Rupture of the is natural disposes to such accidents. Genital during the first intercourse, which disproportion is a very important usually does not require any hospi­ factor which includes cases of coitus talization. More serious mJuries with very young girls or with old have, however, been reported from women where post-menopausal vagi­ time to time by different authors. nal atrophy is present, or when Purpose of this paper is to review 10 the is shortened in an opera­ cases of coital injuries treated in this tion as after hysterectomy. Vagi­ hospital during the last 5 years, and nismus also romes under this category to report a few interesting cases. The according to Rahms as the vaginal very fact that only 10 such cases were tube is narrow and shortened. Other treated in this hospital during 5 years factors related to coital injuries are I. points to the rarity of this accident. brutality, drunkenness, undue haste In young women injuries usually on the part of the male, increased in­ occur at the introitus while in older tra-abdominal pressure by the female. women injuries of the Other rare causes are genital malfor­ are commoner. Dickinson states that mation and scarring of vagina due to the upper part of the vagina is un­ any cause. sup_rorted except for connective tissue In our series of cases age of the fibres lying anterolaterally and form­ patient varied from 4 to 28 years. ing the base of the broad . Patients reported to hospital after Th~ right fornix is larger and is more varying intervals of time, immediate.. liable to stretch due to pocketing of ly after coitus to 3 months later. The glans and that is why injuries of the important points of each case are right fornix are more common, hence given in the following Table. There once the laceration is initiated it may was no death in the series. extend posteriorly, or to the opposite Last three cases require detailed fornix, or down the vaginal sulcus. discussion as they are interesting and unusual. ':'Government Medical College, Patiab. case No. 8. 28 yrs, old, had bleeding per Received for publication on 17-7-64. vaginam immediately after coitus which .. TABLE I () 0 s. Name Date. of Date of ~ Symptoms t- No. ad~Is-discharge Age Gravida Location of injury Treatment SIOn ...... z 1. G.K. 5-5-1961 7-5-1961 16 years Para 0 Bleeding per vaginam imme­ Hymen torn; no vaginal in­ nil q<-< Gravida 0 diately after 1st coitus. volvement. ~ t;J 2. B. 22-7-59 24-7-1959 20 year3 Para 0 Bleeding per vaginam for 2-3 2.5 em tear in right fornix Stitched and packed UJ Gravida 0 days immediately after 1st extending to the . Antibiotics given. coitus. 3. G. 21-5-59 30-5-1959 4 years Unmarried Bleeding per vaginam follow- Hymen & perineal body Stitched in layers ing by an adult male. torn. Antibiotics given.

4. N. 30-3-62 7-4-1962 30 years Para 2 1 Bleeding per vaginam for one 2.5 ;:m tear in left fornix & Stitched and antibio- Gravida 2 day immediately after coi- lateral wall of cervix. tics given. tus. 5. G.K. 25-5-61 10-6-1961 18 years Para 0 Bleeding per vaginam after Tear in right posterior for- Cathet erisation Anti- Gravida 0 1st coitus for 2-3 days. nix 2.5 em long with pelvic biotics given. (ii) Retention of urine for peritonitis. 1 day. (iii) Burning micturition after 2nd day. (iv) Fever for one day. 6. H.K. 23-9-58 25-9-1958 22 years Para 0 Bleeding per vagina after 1st Only hymen torn. Only Antibiotics given. Gravida 0 coitus for 5 days. 7. K. Not admitted 20 years Unmarried Bleeding per vagina imme- Hymen torn & 2 em long Stitched and packed diately after 1st coitus. tear in the right fornix. Antibiotics given.

8. S.D. 6-8-61 18-8-1961 28 years Para 0 (i) Bleeding per vaginam im- R.V.F. ~ em hole 2 em above R.V.F. repaired and Gravida 0 mediately after first post- the intriotus. Antibiotics given. partum coitus on the 20th day of the delivery. (ii) Faeces per vaginam for the last 3 months. 9. P. 17-8-61 26-8-1961 20 years Para 0 (i) Bleeding per vaginam im- 1. Tear in the post. fornix Laparotomy, stitching­ Gravida 0 mediately after coitus. 5 em long. of the fornix after (ii) Something coming out 2. Omental prolapse 6 x 4". withdrawal of intes­ of vagina. 3. Intestinal prolapse in tines and excising the (iii) Slight pain. vagina. omentum. 10. A.N. 25-5-62 28-5-1962 25 years Para 0 Bleeding per vaginam after 5 em long tear extending Stitched and Antibio- Gravida 0 coitus. from the intriotus to left tics given. lateral vaginal wall. w "'>-'

.. 932 JOURNAL OF OBSTETRICS ANP GYNAECOLOGY OF lNDIA

occurred on 20th day after the 4th delivery. days after discharge with profuse bleeding She went to a local hospital for treatment immediately after first coitus after dis­ immediately, where some operation was charge from the hospital. She had 5 em. .. done. She started passing faeces per long tear starting from the introitus to the vaginam on the 4th post-operative day. She left lateral vaginal wall. · General condi­ was admitted here 3 months later with a tion good. complaint of passing faeces per vaginam. Treatment: Tear was stitched with cat­ It could not be determined whether the gut. Vag.na packed and antibiotic given. recto-vaginal fistula was the result of coitus She delivered a · healthy female baby or operation. vaginally 10 months after discharge. On Examination an opening ~ em. size was localised, 2 em. above the introitus. Discussion Treatment: Repair of R.V.F. done. Out of 10 cases 5 had injuries Post-operaLve period uneventful R.V.F. following first coitus after marriage. healed well. Case No. 9. 20 yrs., old, came with slight Two were unmarried girls. The re­ bleeding per vaginam and severe pain im­ maining three cases were multiparas l'1ediately after first coitus. She noticed a who had injuries mainly of the fornix. mass com:ng out of vagina immediately One patient had mJury resulting after coitus. The pain subsided after some from first coitus after the exci­ time. On Examination: General condition sion of a tough septum, i.e. injury good. No regidity of abdomen. No temp, was due to increased friability of pulse and blood pressure normal. tissues after operation and genital dis­ Vaginal Examination: On inspection: proportion. None of these required 5" x 6" of omentum lying outs'de the blood transfusion. There were no vagina. On vaginal examination a loop of intestine was lying in the vagina behind the deaths in the series. Treatment in all omentum. A tear in the posterior fornix, consisted of stitching, packing and could be felt. antibiotics, except in one who had a Treatment: Immediate laparotomy was laparotomy. Post-operative period done and portion of prolapsed omentum was uneventful in all except one who gently withdrawn into the abdomen. Major portion of prolapsed omentum which had post-operative retention of urine was lying outside the vagina was excised due to peritonitis. She was catheris­ because it had become gangrenous. A loop ed and started passing urine herself. of ileum 10" in length was also gently withdrawn into the abdomen. Loop ap­ Summary peared dark in colour. There was slight Ten cases of coital mJury are erosion of serosal surface. It was wrapped analysed with review of literature. in towel wrung in warm saline. The colour ) - of the loop improved and so the loop was References left undisturbed. Tear in the pouch of Doug­ las was stitched with continuous catgut. 1. Burdman, M.: Brit. M. J. 2: 226, Post-operative period uneventful. She was 1948 . . discharged well. She delivered a healthy 2. Conde, A. L.: Rev. Gynec. E. Obst. male baby one year later in this hospital. 1: 383, 1952. Case No. 10. 25 years old, and was 3. Dickinson, R. L.: Atlas of Human getting treatment for sterility in this hospi­ Sex Anatomy, Baltimore, 1949, tal for last 2 years .. Williams and Wilkins Co. On Examination: She had a tough vaginal septum pushed high up by repeated 4. Fish Stewart, A.: Am. J. Obst. & attempts at interecourse. Septum divided Gynec. 72: 544, 1956. and patient discharged. She came three 5. Lask, S.: Brit. M. J. 1: 786, 1948.