Coital Injuries Research Articles

(274) Sexual Assault Resulting in Hemoperitoneum and Multiple Genital Tract Injuries

Abstract Introduction The sexual experience ought to be pleasant and desirable, this case however demonstrates one of such unusual sexual events with catastrophic ending that may have resulted in fatality but for timely surgical intervention. The first coital experience for women may be associated with discomfort but when it is non-consensual the damaging effect of the trauma is deeper and may last for a lifetime. Objective To demonstrate unusual presentation of coital injuries with hemoperitoneum and its management in low resource settings to reduce immediate and long-term effects including death. Methods A case report of an 18-year old nulliparous lady with no prior sexual exposure who presented with vagina bleeding of 18hours following non-consensual penetrative sexual intercourse perpetrated by her religious cleric. Bleeding was in excess of 500mLs with associated lower abdominal pain and dizziness. She presented in hypovolaemic shock with severe anemia (hematocrit - 15%). There was ongoing vagina bleeding with mild abdominal distension. No skin injuries. Results She had genital tract exploration with findings of a 3cm peri-urethral vaginal laceration and a 6cm longitudinal rent on the posterior upper vagina extending to the cervix. The apex of the vaginal laceration could not be visualized from the vagina, necessitating exploratory laparotomy. Findings at surgery include 1.7L of hemoperitoneum and a transverse laceration on the posterior cervix extending into the lower uterine segment about 5cm long. The lacerations were repaired per vagina and per abdomen respectively with hemostasis secured. She had other supportive care including antibiotics, blood transfusion, analgesics, tetanus prophylaxis, Post-exposure prophylaxis for HIV and Hepatitis B immunoglobulin as well as emergency contraceptives. She was counselled with empathy and referred to the clinical psychologist for mental health support to prevent long term mental health effects. The assailant was arrested by the police and charged to court Conclusions Sexual assault may be associated with significant morbidities including unusual presentation such as hemoperitoneum and cervico-uterine laceration even in the absence of obvious skin injuries. Early presentation and appropriate intervention can help limit the adverse outcomes that may be associated as well as long term sequelae. Disclosure No.

Nonobstetric lower genital tract injury patients of a tertiary care center in Eastern Uttar Pradesh, India: A cross-sectional study.

Injuries of lower genital tract are commonly seen in obstetrics patients during labor and delivery. Nonobstetric genital injuries are seen less commonly. Research on injuries to the lower genital tract from nonobstetric trauma is therefore scant. The purpose of this study was to document causes, treatment, and outcomes among patients of lower genital tract injuries visiting to B. R. D. Medical College and Nehru hospital, Gorakhpur, U.P. Admission and operation theater registers of the department of obstetrics and gynecology during 1 year were scrutinized for cases admitted with the diagnosis of genital trauma. Bed-head tickets of patients were scrutinized with the help of a data abstraction form, and information regarding age, cause of injury, site, size and pattern of injuries, treatment, and short-term outcome were recorded. Of a total of 43 cases of traumatic genital tract injuries, 39 women received treatment. Maximum cases were seen in girls aged 6-10 years. Three women were pregnant at the time of injury. Noncoital injuries predominated over coital injuries, i.e., 59% versus 38.4%. Among the noncoital injuries, fall was the most common cause accounting for 75% of the cases. Coital injuries following consensual sex occurred more commonly in women who were sexually active, lactating, or postmenopause. The chief presenting complaint was vaginal bleeding. Vaginal wall laceration/tear was the most common injury reported. Multiple injuries were seen in 40% (17/39) of the cases. Twenty-one cases of laceration/tear (53.8%) were repaired surgically of which seven required examination and repair under anesthesia. Vulvar hematomas were managed by incision and drainage. There was no major morbidity or mortality. The results of this study from eastern Uttar Pradesh, India, support those from other developing nations. Noncoital injuries were found to be the most predominant cause of non-obstetric genital trauma, though, contrary to others, children were seen to be at the greatest risk. It is important to teach children about playing safely and following safety measures while on the road. We must also make them aware so that they do not become victims of rape.

Coital trauma as seen at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

<p class="abstract"><strong>Background:</strong> Though pleasurable, coitus may result in morbidity and even mortality. One of such morbidities is coital trauma, a global occurrence that is grossly under reported. This study aimed to determine the causes and risk factors for coital trauma as well as its clinical presentation.</p><p class="abstract"><strong>Methods:</strong> This was a 4 year retrospective study of patients that presented with coital injuries at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Data were obtained from patients’ clinical notes using a specially designed proforma. Statistical analysis was performed using Epi Info<sup>TM </sup>7.2.1. </p><p class="abstract"><strong>Results:</strong> The majority of women that presented with coital trauma were adolescents (67.9%). Most of them were single (92.9%), nulliparous (89.3%) and had only primary education (57.1%). The commonest cause of coital trauma was rape (75%). The commonest risk factors were inadequate foreplay (57.1%) and coitarche (42.9%). Other risk factors were genital disproportion, pregnancy, puerperium and influence of drugs. The common clinical presentations were vaginal bruises (75%) and vaginal lacerations (64.3%) while the commonest site of injury was the hymen (42.9%) followed by the vulva (35.7%). Other less common sites of injury were the lower vagina and posterior fornix.</p><p><strong>Conclusions:</strong> Coital trauma is relatively common and young girls are mainly affected. Rape is the major cause while inadequate foreplay and coitarche are the major predisposing factors. </p>

Penile coital injuries in men decline after circumcision: Results from a prospective study of recently circumcised and uncircumcised men in western Kenya.

BackgroundPenile coital injuries are one of the suggested mechanisms behind the increased risk of HIV among uncircumcised men. We evaluated the prevalence and correlates of self-reported penile coital injuries in a longitudinal community-based cohort of young (18–24 years old), newly circumcised and uncircumcised men in Western Kenya.MethodsSelf-reported penile coital injuries were assessed at baseline, 6, 12, 18 and 24 months of follow-up, and were defined as scratches, cuts or abrasions during sex, penile soreness during sex, and skin of the penis bleeding during sex. Associations between penile coital injuries, circumcision, sexual satisfaction, and other covariates were estimated with mixed effect models.ResultsBetween November 2008 and April 2010 3,186 participants were enrolled (1,588 into circumcision group and 1,598 as age-matched controls). Among 2,106 (66%) participants sexually active at baseline, 53% reported any penile injury, including 44% scratches, cuts or abrasions; 32% penile pain/soreness; and 22% penile bleeding. In multivariable modeling, risk was lower for circumcised men than uncircumcised men for scratches, cuts and abrasions (aOR = 0.39; 95% CI 0.34–0.44); penile pain/soreness (aOR = 0.58; 95% CI 0.51–0.65), penile bleeding (aOR = 0.53; 95% CI 0.46–0.62), and any penile coital injuries (aOR = 0.47; 95%CI 0.42–0.53). Other significant risk factors included increasing age, history of STIs and genital sores, and multiple sex partners, while condom use was protective. Coital injuries were significantly associated with lower levels of sexual satisfaction in longitudinal analyses (scratches, cuts or abrasions: aOR = 0.87, 95% CI: 0.76–0.98; penile pain/soreness: aOR = 0.82, 95% CI: 0.72–0.93; and penile bleeding: aOR = 0.65, 95% CI: 0.55–0.76).ConclusionsSelf-reported penile coital injuries were common and decreased significantly following circumcision. Improving sexual experience through the removal of a potential source of sexual discomfort may resonate with many men targeted for circumcision services. The role of penile coital injuries in sexual satisfaction, HIV, HSV-2, and as a motivator for seeking circumcision services should be explored further.

Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal

The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Appropriate surgical intervention can avert morbidity and mortality.

Sexual Pleasure and Function, Coital Trauma, and Sex Behaviors After Voluntary Medical Male Circumcision Among Men in the Dominican Republic

BackgroundVoluntary medical male circumcision (VMMC) is effective in decreasing the risk of HIV acquisition. As men resume sexual activity after circumcision, it will be important to study their satisfaction with the procedure, sexual pleasure and function, coital trauma, and risk compensation (RC), which can hamper or facilitate the long-term success of VMMC programs. AimTo assess men's satisfaction with VMMC, sexual pleasure and function, coital trauma, and RC after VMMC. MethodsThis is a cohort study of circumcised men who presented for follow-up 6 to 24 months after VMMC. Logarithmic binomial regression was performed to explore factors associated with any increase in the number of sex partners after VMMC as a measurement of RC. Main Outcome Measures(i) Men's satisfaction with their VMMC; (ii) sexual pleasure and function after VMMC; (iii) coital trauma; and (iv) RC. ResultsOf 454 circumcised men, 362 (80%) returned for a follow-up visit 6 to 24 months after VMMC. Almost all (98%) were satisfied with the outcome of their VMMC; most (95%) reported that their female partners were satisfied with their circumcision. Two thirds (67%) reported enjoying sex more after VMMC and most were very satisfied or somewhat satisfied (94%) with sexual intercourse after VMMC. Sexual function improved and reported sex-induced coital injuries decreased significantly in most men after VMMC. There was an increase in the proportion of men who reported at least two sexual partners after VMMC compared with baseline. In multivariate analysis, having sex with a woman they met the same day (adjusted relative risk = 1.7, 95% CI = 1.2–2.4) and having at least two sexual partners at baseline (adjusted relative risk = 0.5, 95% CI = 0.3–0.8) were associated with the outcome of any increase in the number of partners after VMMC. Clinical ImplicationsVMMC can be offered to Dominican men for HIV prevention without adversely affecting sexual pleasure or function. The procedure substantially reduces coital trauma. Strengths & LimitationsThis is the first report of long-term overall satisfaction, sexual pleasure/function and sex behaviors in the context of VMMC outside of Africa. Limitations of the study included the reliance on self-reported sex behaviors, the lack of physiologic measurement of penile sensitivity and the lack of follow up data beyond 24 months, which precludes the assessment of longer term RC. ConclusionThe study confirmed men's long-term satisfaction with the outcome of their VMMC. VMMC improved sexual pleasure and function for most men and significantly decreased coital injuries. There was mixed evidence of RC.Brito MO, Khosla S, Pananookooln S, et al. Sexual Pleasure and Function, Coital Trauma, and Sex Behaviors After Voluntary Medical Male Circumcision Among Men in the Dominican Republic. J Sex Med 2017;14:526–534.

NON-OBSTETRICAL VAGINAL TRAUMA: CAUSES AND COMPLICATIONS

Non-Obstetrical vaginal trauma in a common occurrence but is under reported. It is commonly related to coital trauma but may also be a consequence of direct penetrating trauma. automobile accident and post menopausal atrophy. All these injuries may range from minor vaginal laceration to life threatening hemorrhage. The peculiar thing about these injuries is marked delay in seeking professional help as a patient perceives it as a social stigma. History may be miss- leading, with resistance in examination .under estimation of blood loss leading to erroneous diagnosis and hence delayed prompt treatment.
 Objective; Our study intends to the report the relative contribution of various causes leading to non-Obstetrical vaginal trauma with its resultant morbidity and mortality amongst patient managed in its tertiary care hospital and two private hospital during the study period.
 Material & Methods: It was descriptive study from 1st July 2015 to 30 June 2016 at Lahore general hospital which is a teaching hospital attached to Ameer ud din medical collage and post graduate medical institute. Researchers also included cases managed in two private hospitals. All cases with suspicion of sexual assault and medicoligal involvement were excluded. These patients underwent examination under anesthesia for exact anatomical location of injury, any collateral damage and primary definite surgical repair along with blood transfusion. They were advised to come for follow up six weeks latter.
 Results: Collectively 40 patients of non-Obstetrical vaginal trauma were managed as emergency cases majority 34 cases (85 %) were due to coital trauma and six cases (15%) due to non-coital trauma, commonest mode of presentation was vaginal bleed with varying degree of shock 28 cases (70 %), bilateral valval hematoma four cases (10 %), fecal incontinence from 4th degree perinea tear two cases (05%), urinary incontinence one case (2.5 %) and urinary retention one case (2.5 %). Blood transfusions were required in 37 causes ranging from 02 to 12 units of blood. Transfusion reaction developed in four cases (10.8 %), sepsis in two cases (5.4 %), acute renal failure necessitating dialysis in one case (2.7 %). One patient died of hemorrhagic shocked. Only 11 cases reported for follow up visit, 06 had depression, 03 deep dysparenia and two vaginismus. Rest were lost to follow up.
 Conclusion: Our study concluded that the most common cause of non-obstetrical vaginal trauma is coital injury sustained at consummation of marriage. Although majority recovered well yet its prevention poses a great challenge to the gynecologist community.

Retrospective Analysis of Clinical Features, Treatment and Outcome of Coital Injuries of the Female Genital Tract Consecutive to Consensual Sexual Intercourse in the Limbe Regional Hospital.

IntroductionNonobstetrical genital injuries are gradually becoming a common cause of genital injuries. Consensual sex has been reported to be a possible cause of this type of injuries, but its contribution to traumatic lesions of the female genital tract is not well known. It has been suggested that injury consecutive to consensual sex can be extensive and life‐threatening.AimThe aim of this study was to analyze the clinical features, treatment modalities, and the outcome of injuries to the female genital tract consecutive to a consensual sexual intercourse.MethodsA retrospective review of records of female patients admitted in our institution with a complaint of genital injury over a 5‐year period. We collected data regarding patient and injury characteristics, findings of the gynecologic examination, modalities of management and final outcome.Main Outcome MeasuresAnatomic location and nature of injury, modalities of management, admission rate and mortality rate.ResultsForty six cases could be analyzed. Their mean age was 25.6 years. Almost 35% of patients sustained the injury during their first sexual contact. The majority presented with bleeding, often combined with pain. One patient presented with features of peritonitis. During examination, no anatomic lesions could be identified in 16 (34.8%) of patients. When a lesion was present, it concerned mostly the posterior fornix (28.3%) and the lateral vaginal wall (10%). The most frequently described lesion was a laceration. The majority of patients (83%) were treated with suturing under local anesthesia. The admission rate was 28%, and was significantly higher in patients with a laceration of the posterior fornix. No death was recorded.ConclusionsCoital injuries following consensual sex often present in the form of a life‐threatening condition and young female with no previous sexual experience are particularly exposed. Most lesions can be treated with a simple suture. T chounzou R and C hichom‐ M efire A . Retrospective analysis of clinical features, treatment and outcome of coital injuries of the female genital tract consecutive to consensual sexual intercourse in the L imbe R egional H ospital. S ex M ed 2015;3:256–260.

A RARE CASE OF RECTOVAGINAL FISTULA CAUSED BY COITAL INJURY IN A PATIENT OF MRKH

Rectovaginal fistula is defined as an epithelized communication between the rectum and vagina with involuntary escape of flatus and/or faeces into the vagina. Rectovaginal fistula is a very distressing problem for women. The successful management of this problem depends on the etiology, size and location of both fistula, as well as assessing the competence of the continence mechanism. It may be acquired and congenital, the most common causes are obstetrical injury. Coital injury is very rare cause of recto vaginal fistula. Here we are reporting a rare case of MRKH along with recto vaginal fistula resulting from coital trauma.

Mayer-Rokitansky-Kuster-Hauser syndrome presenting as rectovaginal fistula

Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome is a Mullerian abnormality, characterized by the absence of the vagina, associated with abnormal or absent uterus and the presence of apparently normal tubes and ovaries. Physical growth development and secondary sexual characters as well as the external genitalia are also normal. These patients usually present with primary amenorrhea. Here we report a case of 20-year-old woman with primary amenorrhea due to Mullerian agenesis presented with rectovaginal fistula following coital injury. To the best of our knowledge, this is the first case reported in the literature with this rare presentation.

Increase in fracture of the penis in south-west Nigeria

ObjectiveTo present our recent experience in the management of penile fracture. Patients and methodsWe present 21 cases of penile fracture managed at the two Federal-owned tertiary hospitals in two neighbouring states in south-west Nigeria between 2001 and 2011. The diagnosis was based mainly on a clinical evaluation. The treatment was surgical in patients who presented within 2weeks of the fracture. The emphasis during the follow-up was on erectile function and micturition. ResultsSeventeen patients presented within 48h, two presented after a week, while two reported months later with penile deviation. The mean age of the patients was 26.4years. The cause of fracture was sexual intercourse in 11 (52%) patients and forceful manipulation of the erect penis in 10 (48%). Thirteen (62%) of all injuries occurred in the last 2years of the study, of which eight men were injured during rear entry with the woman on top (reverse coital) position. Six of the patients with reverse coital injuries reported trying the position after watching it on the Internet, specifically on their cellular phones. Eighteen patients had surgical treatment, with a satisfactory outcome. Two of the other three patients had penile deviation during erection. ConclusionsThe incidence and causes of penile fracture appear to have changed drastically over the last 2years in our environment. The rapid demographic changes in south-west Nigeria are probably responsible. There appears to be a relationship between the cause of fracture and the use of the Internet, although that might be coincidental. Surgical repair, irrespective of the delay before intervention, usually offers a satisfactory outcome.

P3-S5.01 Microbial diversity of genital ulcer disease in men enrolled in a randomised trial of male circumcision in Kisumu, Kenya

BackgroundMedical male circumcision (MMC) reduces the risk of HIV acquisition by ∼60%, in part by reducing genital ulcer disease (GUD) and HSV-2. In the Ugandan and Kenyan trials, PCR did...

Vaginal lacerations from consensual intercourse in adolescents

Objective (1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries. Methods We present a case series of 4 female adolescent patients seen at a children's hospital over a period of 6 months. Each patient developed significant vaginal bleeding after sexual intercourse, and 3 of the patients presented to the emergency department with vital signs consistent with compensated shock. Results Each patient was evaluated by pediatric surgery, and found to have a laceration of the vagina. Three of the patients described consensual intercourse prior to the onset of bleeding, and had lacerations of the vaginal fornices; these patients were determined to have injuries resulting from consensual sexual intercourse. The fourth patient reported sexual assault as the cause of her injuries, and was treated for longitudinal lacerations of the vaginal wall. Conclusions Lacerations of the upper vagina are not frequently reported in forced vaginal intercourse, but are occasionally reported as injuries sustained during consensual coitus. In the absence of reported sexual assault, a severe vaginal fornix laceration is consistent with the diagnosis of coital injury from consensual intercourse. Diagnosis and treatment of this injury can be delayed due to the sensitive nature of these injuries. Bleeding can be profuse, leading to hemorrhagic shock, and these injuries may require transfusion of blood products and surgical repair in some cases. Complications may include hemoperitoneum, pneumoperitoneum, or retroperitoneal hematoma, even in the absence of complete vaginal perforation. Practice implications Knowledge of the consensual sexual injuries that may occur in adolescent patients can guide diagnosis, treatment, and counseling for the patient and her family, preventing long-term medical complications and legal consequences.

Circumcision and Reduced Risk of Self-Reported Penile Coital Injuries: Results From a Randomized Controlled Trial in Kisumu, Kenya

Circumcision and Reduced Risk of Self-Reported Penile Coital Injuries: Results From a Randomized Controlled Trial in Kisumu, Kenya

Circumcision and Reduced Risk of Self-Reported Penile Coital Injuries: Results From a Randomized Controlled Trial in Kisumu, Kenya

Injuries to the penis during intercourse represent a hypothesized mechanism by which uncircumcised men are at increased risk for HIV. There are no published, systematically collected data regarding mild penile coital trauma to our knowledge. We identified risks of self-reported penile coital injuries in men 18 to 24 years old in a randomized trial of circumcision to prevent HIV in Kisumu, Kenya. Each participant underwent standardized interview, medical history and physical examination at baseline, and 6, 12, 18 and 24 months after enrollment. Self-reported penile coital injuries were assessed at each visit, and were defined as penis feels sore during sex, penis gets scratches, cuts or abrasions during sex, and skin of the penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios for penile coital injuries. From February 2002 to September 2005, 2,784 participants were randomized. At baseline 1,775 (64.4%) men reported any coital injury including 1,313 (47.6%) soreness, 1,328 (48.2%) scratches, abrasions or cuts and 461 (16.7%) bleeding. On multivariable analysis coital injury risk was lower for circumcised than for uncircumcised men with soreness (OR 0.71, 95% CI 0.64-0.80), scratches/abrasions/cuts (OR 0.52, 95% CI 0.46-0.59), bleeding (OR 0.62, 95% CI 0.51-0.75) and any coital injury (OR 0.61, 95% CI 0.54-0.68). Other significant risks included increasing age, multiple recent sex partners, HSV-2 seropositivity and genital ulcers (p <0.05). Condom use, cleaning the penis soon after intercourse and being married/cohabiting were protective (p <0.05, each). Self-reported penile coital injuries were common in these healthy young men. Circumcised men were at lower risk for coital injuries. Verifying penile coital injuries, the mechanism of acquisition and the association with HIV risk is needed.

18 FREQUENT OCCURRENCE OF SELF-IDENTIFIED PENILE COITAL INJURIES IN HEALTHY YOUNG MEN: PROTECTIVE EFFECT OF CIRCUMCISION

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 201018 FREQUENT OCCURRENCE OF SELF-IDENTIFIED PENILE COITAL INJURIES IN HEALTHY YOUNG MEN: PROTECTIVE EFFECT OF CIRCUMCISION John Krieger, Supriya Mehta, Stephen Moses, Kawango Agot, Jeckoniah Ndinya-Achola, Corette Parker, and Robert Bailey John KriegerJohn Krieger Seattle, WA More articles by this author , Supriya MehtaSupriya Mehta Chicago, IL More articles by this author , Stephen MosesStephen Moses Winnipeg, Canada More articles by this author , Kawango AgotKawango Agot Kisumu, Kenya More articles by this author , Jeckoniah Ndinya-AcholaJeckoniah Ndinya-Achola Nairobi, Kenya More articles by this author , Corette ParkerCorette Parker Research Triangle Park, NC More articles by this author , and Robert BaileyRobert Bailey Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.061AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To identify factors associated with penile coital injuries in healthy men aged 18-24 enrolled in a randomized trial of circumcision to prevent HIV infection in Kisumu, Kenya. METHODS Participants underwent personal interview, medical history and examination at baseline and 6, 12, 18, and 24 months. Reported coital injuries occurring in the past 6 months were assessed at each visit: penis feels sore during sex; penis gets scratches, cuts or abrasions during sex; skin of penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios (OR) for reported penile coital injuries by circumcision status, behavioral risks, and lab diagnosed sexually transmitted infection (STI) as time-varying covariates except HSV-2 serostatus and age at baseline. RESULTS February 2002-September 2005, 2,784 participants were randomized and 2,757 answered all penile injury questions at baseline. There were 1,775 men who reported any coital injury: 1,313 (47.6%) soreness; 1,328 (48.2%) scratches, abrasions, or cuts; and 461 (16.7%) bleeding. For the circumcision and control groups, respectively, report of any injury decreased from 65.1% and 64.0% at baseline to 31.3% and 42.1% at month 24. In multivariable analysis, the risk of coital injury over time was significantly lower for circumcised than for uncircumcised men: soreness [OR=0.71, 95% CI 0.64-0.80], scratches/abrasions/cuts [OR=0.52, 95% CI 0.46-0.59], bleeding [OR=0.62, 95% CI 0.51-0.75], or any coital injury [OR=0.61, 95% CI 0.54-0.68]. Other significant risks (p<0.05) included: increasing age (OR=1.07), multiple recent sex partners (OR=1.38), HSV-2 seropositivity (OR=1.37), and genital ulcers (OR=1.72). Condom use (OR=0.78), cleaning the penis soon after intercourse (OR=0.85), and being married/cohabiting (OR=0.76) were protective. CONCLUSIONS Self-reported penile coital injuries were common in these healthy young men. Circumcised men were at lower risk for coital injuries, though their prevalence of injuries remained high. Risk factors associated with penile coital injury were similar to risk factors for STI and HIV. Verifying penile coital injuries and the mechanism of acquisition are necessary to understand how penile coital injuries might increase STI and HIV risk © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e8 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Krieger Seattle, WA More articles by this author Supriya Mehta Chicago, IL More articles by this author Stephen Moses Winnipeg, Canada More articles by this author Kawango Agot Kisumu, Kenya More articles by this author Jeckoniah Ndinya-Achola Nairobi, Kenya More articles by this author Corette Parker Research Triangle Park, NC More articles by this author Robert Bailey Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Vaginal Laceration and Hemorrhagic Shock during Consensual Sexual Intercourse

Coital injury causing severe vaginal laceration is not uncommon during first coitus. However, hemorrhagic shock during consensual sexual intercourse is quite rare. In this report, there was one 30-year-old, 20-year-old one, and one 24 year-old women who suffered severe vaginal laceration and bleeding during the process of consensual coitarche. All subjects were transferred to the hospital in the condition of impending shock. We found that the lacerated sites were located at right posterior fornices in all cases. We postulate that these vulnerable sites of vaginal laceration may be due to the dextro-rotation characteristics of the uterus and the distensibility of the vagina in this area. The vaginal fornix can be extremely distended during sexual intercourse, making it vulnerable to laceration in this area. Besides, there was a disproportionate genital size in all three cases which may be a cause of vaginal laceration. It is critical that such patients receive a prompt diagnosis to provide efficient management. It needs only simple surgical skills to cure the injury if the vital signs are stable. However, those survivors may need further psychological consultation to prevent negative impact on their future sexual functioning.

Female consensual coital injuries.

To ascertain the pattern and management strategies of coital injuries in married females in Pakistan. An observational, case series. Gynaecology and Surgical wings - Fatima Medical Centre, Multan, over a period of seven years from January 1997 to December 2003. Records of 33 adult married females sustaining coital injuries were studied. Only married females were included. Injuries raising suspicion of indecent assault, sexual abuse and trauma were excluded. Results were recorded and analyzed. Three vulvar haematomas (9%) settled on conservative management. One labial (3%), 9 posterior fourchette (27%) and 16 vaginal wall lacerations (48%) were stitched. A broad ligament haematoma (3%) and a ruptured ovarian cyst (3%) were laparoscopically dealt with. One posterior fornix perforation (3%) with secondary peritonitis and a ruptured ectopic pregnancy (3%) with life-threatening haemorrhage underwent laparotomy. No mortality occurred in this series. Varied presentation of the coital injuries demand careful evaluation to help correct diagnosis, timely management and successful outcome with minimal morbidity.

An unusual case of dyspareunia

An acute onset of dyspareunia may result from coital injury to the reproductive tract. We present a case of dyspareunia resulting from a uterosacral ligament haematoma, which appears to have occurred during intercourse. On review of the literature, we found no similar cases reported.

Fracture of the penis.

Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial. A Medline search from January 1966 to July 2001 using the terms 'fracture of penis', 'penile trauma' and 'coital injuries' was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome. In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction. Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.