Coitus induced vaginal evisceration in a premenopausal woman: a case report

This article highlights coitus as a trigger event for inducing vaginal evisceration and that vaginal evisceration caused by sexual intercourse should be considered in the field of surgery when a pre-menopausal woman presents with acute abdominal pain with no history of any other traumatic episode.Hysterectomy is an extremely common procedure performed routinely on a global basis with recognized complications which include infection, bleeding, bladder injury and prolapse of the vaginal vault [1].Vaginal evisceration after transabdominal hysterectomy in a pre-menopausal patient with vault rupture and prolapse of small bowel during sexual intercourse is an extremely rare event, and when it occurs, it is a surgical emergency [2,3].Since the first report in 1864 by Hyernaux, 113 cases have been reported in medical literature [4]. Joy et al. identified 12 cases of vaginal cuff evisceration resulting from coitus and 9 of these cases were post-vaginal hysterectomy [3].In premenopausal cases, evisceration appears to be rarer and tend to be associated with either sexual or obstetric trauma, while in post menopausal women, it is usually associated with atrophic vaginal wall which have an increased risk of rupture [1].Here we report a case of coitus-induced vaginal evisceration in a pre-menopausal female patient, with prolapse of around 1 meter of small bowel through the vagina; who had undergone abdominal hysterectomy two years back for dysfunctional uterine bleeding (DUB).A 40 year old, South Indian, premenopausal female with an obstetric score of P2 L2 presented with a progressive lower abdominal pain from 4 days, a feeling of something giving way in the vagina during bowel motion from 4 days and a mass protruding through her vagina from 3 days.The pain had become progressively worse, was constant in nature and accompanied by nausea.Her last sexual intercourse had been 4 days earlier, at which time she had experienced lower abdominal discomfort and slight vaginal bleeding. S