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.
Highlights
Vaginal perforation is associated with a previous history of pelvic surgery, most often hysterectomy; associated with a previous history of pelvic surgery, most extremes often hysterectomy; there are other predisposing factors, such as abstinence, of age, genital infecthere are other predisposing factors, such as abstinence, extremes of age, genital infections, tions, specific coital positions and congenital genital abnormalities [1]
We report a case of vaginal perforation with organ evisceration after a consensual We report a case of vaginal perforation with organ evisceration after a consensual sexual intercourse in a woman without history of pelvic surgery or disease
Criteriaof the papers, we included articles focused on post-coital vaginal perforation and evisceration in women prior pelvic surgery or any of the papers,without we included articles focused onpredisposing post-coital vagina medical disease
Summary
Perforation of the vagina is a rare condition in clinical practice and, when it is associof the vagina a rare condition in clinical and, when it is assoated Perforation with evisceration, it is a is surgical emergency.In mostpractice cases, vaginal perforation is ciated with evisceration, it is a surgical emergency.In most cases, vaginal perforation is associated with a previous history of pelvic surgery, most often hysterectomy; associated with a previous history of pelvic surgery, most extremes often hysterectomy; there are other predisposing factors, such as abstinence, of age, genital infecthere are other predisposing factors, such as abstinence, extremes of age, genital infections, tions, specific coital positions and congenital genital abnormalities [1].specific coital positions and congenital genitalthe abnormalitiesthere is scant literature about presentation,[1].diagnosis and managementthere is scant literature about the presentation, and management of post-coital vaginal rupture. Vaginal perforation is ciated with evisceration, it is a surgical emergency. Vaginal perforation is associated with a previous history of pelvic surgery, most often hysterectomy; associated with a previous history of pelvic surgery, most extremes often hysterectomy; there are other predisposing factors, such as abstinence, of age, genital infecthere are other predisposing factors, such as abstinence, extremes of age, genital infections, tions, specific coital positions and congenital genital abnormalities [1]. There is scant literature about the presentation, and management of post-coital vaginal rupture. These injuries are notdiagnosis life-threatening conditions of post-coital vaginal rupture These injuries are not life-threatening conditions but, a delay in diagnosis can lead to severe complications. The embarrassment of many women makes the anamnesis and, so, the diagnosis more difficult and delayed
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