Life threatening consensual coital laceration in the seventh decade; a case report

Abstract

Background: Non-obstetric injuries to the female genital tract are becoming a frequent cause of gynecological emergencies. These injuries appear to be more common in young, inexperienced patients. However, occurrence in the seventh decade seems uncommon and probably under reported. Sexual arousal is known to decline with age and in the presence of certain medical illnesses such as diabetes mellitus. The posterior fornix is the most frequent site of injury and may be consequent upon postmenopausal changes in the elderly. Case presentation and management: A 70-year-old P5'° (4 Alive) postmenopausal patient who presented with bleeding per vaginaam of 6 hours duration following vigorous sexual intercourse with spouse. Evaluation at presentation revealed a hypotensive patient (B/P 80/40mmhg) with moderate anemia (PCV 23%) and copious blood clots at the perineum. She subsequently had an examination under anesthesia (EUA) and repair of a posterior fornix laceration measuring about 4cm. She was transfused with 2 units of whole blood and discharged home after 24 hours of observation. The couple was counselled on the need for adequate foreplay even in old age and early resort to the use of lubricants to prevent future occurrence. Conclusion: Sexual and reproductive health rights of the elderly seem to take backstage in the society with very little attention from relevant stake holders. Late presentation as demonstrated in this case, culminating in hemorrhagic shock may be a reflection of the societal stigma attached to sexuality in the elderly. There is therefore a need to focus on geriatric sexual needs of low-income countries with the goal of providing information and supportive care.