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Abstract: The patient in this case is a 26-year-old female who reported that she had vaginal bleeding for half an hour after one intercourse with pain and pale complexion and lips after a long period of separation between husband and wife. After a brief communication, the patient was examined and relevant tests were performed on her, including routine blood count and coagulation time, which later confirmed the diagnosis of vaginal laceration and mild anemia. After giving medication and surgical treatment, there was no active bleeding or exudation and the wound healed, and the patient was discharged successfully.
Basic information】Female, 26 years old
Type of disease】Vaginal laceration, mild anemia
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】May, 2020
Treatment plan】Surgical treatment (vaginal wall suture) + medication (cefuroxime tablets to prevent infection + ferrous sulfate tablets) + vulva care
Treatment period】5 days in hospital, 4 days postoperative review
Effectiveness】No active bleeding and no exudation after surgery, wound healed and discharged successfully
I. Initial consultation
The patient reported that she had vaginal bleeding for half an hour after intercourse, accompanied by pain, with pale face and lips, clear consciousness, and able to answer questions correctly. There was no abnormality in cardiopulmonary auscultation, the abdomen was flat and soft without pressure pain, the vulva was normally developed, a large amount of blood stain was seen and fresh blood came out of the vagina. After opening the vagina with a speculum, an irregular fissure about three centimeters long was seen in the posterior wall of the vagina, and fresh blood flowed from the fissure. On examination, it was found that the vaginal mucosal layer was lacerated and the rectal wall was not injured, and the laboratory was immediately notified to collect blood for coagulation time and routine blood tests. The routine blood test results showed that the Hb was 87g/L, the WBC was 7.93×10＾9/L, the coagulation time was normal, and the diagnosis was mild anemia.
II. Treatment history
The patient was then given iodophor to routinely disinfect the vulva and vagina, a vaginal puller to expose the posterior vaginal wall, and the left index finger with sterile gloves to reach into the anus to suture the vaginal wall with a total of five stitches. On examination, there was no active bleeding and the stitches did not pass through the rectum. The instrument gauze was counted and the vaginal wound was disinfected again. After surgery, the patient was instructed to scrub the vulva with iodophor twice a day, rest in bed, and eat a light diet rich in dietary fiber to avoid dry stools and avoid straining during defecation to avoid wound pain and healing. After the operation, he was advised to take oral cefuroxime tablets to prevent infection and ferrous sulfate tablets to correct anemia. The patient was discharged after 5 days of hospitalization.
III. Treatment effect
After clinical suturing to stop bleeding, there was no active vaginal bleeding, but a little light pink discharge. After strengthening vulvar care and oral medication to prevent infection, and adding blood tonic medication, the stitches were removed 5 days after surgery, and the vulva and vagina were examined for local redness and swelling, no abnormal exudation, and the wound healed in one stage without obvious tenderness. At the follow-up examination 4 days after the operation, the examination showed that the hemoglobin was 109g/L, red blood cell was 3.32×10＾12/L, the urine and stool were normal, and the body temperature was normal.
IV. Precautions
In this case, the patient’s symptoms were relieved by active treatment, and the patient was discharged successfully. However, after discharge, it is still recommended that the patient should strengthen the local care of vulva, insist on scrubbing the vulva with iodophor 1-2 times a day, and wash it with warm water after each bowel movement or urination. It is also recommended to be gentle during sexual intercourse afterwards to avoid damage to the vaginal and perineal mucosa due to violence. Eat a diet rich in dietary fiber, avoid spicy and stimulating foods, and develop good bowel habits to ensure a smooth flow.
V. Personal insight
If couples have rough sex, it will lead to vaginal mucosal damage and anemia. Learn from this case and be gentle during sex to avoid mucosal damage. It is very important to take better care of the vagina in daily life. If the vaginal mucosa is inflamed and the tissue becomes brittle, it is more likely to be damaged by the friction during sex. Therefore, if there is abnormal color and shape of vaginal discharge and local burning sensation in the vagina, it is recommended to seek medical attention in time, and avoid delaying the treatment because of shyness, which may lead to serious consequences.
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