Severe vaginal hemorrhage requiring surgical repair after consensual sex: a retrospective review in one medical center
Padoa, A1; Glick, N2; Smorgick, N2
1: Yitzhak Shamir Medical Center, Israel; 2: Yitzhak Shamir Medical Center
Objective: To assess the prevalence and clinical features of severe bleeding from vaginal lacerations following consensual sex, which required surgical repair in our institution, during the last decade.
Material and Methods: Following IRB approval, we carried out a retrospective search of our institutions’ computerized database and identified surgical procedures coded as “Suture of Vagina”. We assessed all relevant clinical files and excluded cases of trauma not related to sexual activity and cases resulting from sexual assault.
Results During the decade 2008-2017, twenty patients with severe vaginal bleeding underwent hemostatic suturing in our department. Average age was 27.6 (16-63) years, five patients were parous, 13 patients used no contraception and only one was on birth control pills. Three patients were post-menopausal. Eight cases occurred following first-time intercourse and two cases after sex with a new partner. Mean time from bleeding onset to admission was 12.6 (2-24) hours. On presentation, average pulse was 100 (44-150) bpm, systolic BP was 120 (81-151) and diastolic BP was 70 (41-98). Mean values for blood tests upon admission were HB=12.2 (7.6-14.4) g/dL, INR=1.06 (0.91-1.3), PLT=281 (60-397) K/mcL, WBC=12000 (5700-23800) cells/mcL. Time from admission to surgery averaged 101 (15-540) minutes. On examination under anesthesia, the laceration site was identified at the vaginal fornix in nine patients, with no side predominance: the posterior fornix was involved in 4 cases, the right fornix in three cases and the left fornix in three cases. In four patients, the tear was detected at the level of the mid-vagina. In six women, the tear involved the hymenal ring or the posterior fourchette: all such cases occurred on the patient’s first coitus. Tear of a longitudinal vaginal septum was identified in one patient. Follow-up HB averaged 9.2 (5.6-13.1) g/dL, one patient required transfusion of 2 packed cells units.
Conclusions: Vaginal tears following consensual sex are not uncommon and may expose women to clinically significant hemorrhage, requiring hemostatic suturing under anesthesia and administration of blood products.
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