Consensual coital laceration of the posterior vaginal fornix with hemorrhagic shock in a teenage girl: Diagnostic and management challenges.

INTRODUCTION Life threatening injuries can result from consensualcoitus. In most parts of Africa where children areraised without adequate sex education, and sex isseen as shameful topic and taboo in extreme cases,coital injuries are unlikely to be reported or may bemisdiagnosed and mismanaged. This may result inmorbidities and mortalities. Scarcity of data on thissubject underscores the need for this case report tocreate awareness and add to the body of knowledge.Case report: Patient was 17-year old student whopresented with hemorrhagic shock to the emergencyunit of a reference hospital in Southern Nigeria with a4 hour history of torrential vaginal bleeding and 2fainting episodes following consensual coitus. Historywas misleading as patient, initially, denied anyhistory of sexual activity. However, with a moretactful and empathic approach, the patient admittedhaving consensual coitus prior to symptoms. Onexamination, she was found to have sustainedlacerations of the posterior vaginal fornix. She waspromptly resuscitated and a repair under anesthesiawas done in the theatre. She was transfused with 2units of blood and discharged in good condition after48 hours on admission. CONCLUSIONConsensual coital injuries could be life threatening,yet may be misdiagnosed and poorly managed due toshame and stigma associated with it in ourenvironment. Lack of awareness, low index ofsuspicion, poor approach to history and managementcould lead to poor outcome. High index of suspicion,tact, privacy, empathy, good clinical judgment andmultidisciplinary approach to care are essential toearly diagnosis and good management of coitalinjuries