A rare case of rectovaginal fistula following consensual vaginal intercourse

Abstract

Introduction: Postcoital nonobstetric vaginal lacerations due to consensual sexual act are generally minute mucosal tears. In some cases, the vaginal mucosa is lacerated deeper and the bleeding may require suturing of opened vessel ends or even transfusion.

Aim: The aim of this case report is to present a rare case of acute fistula formation by penile penetration through the full thickness of the rectovaginal wall after consensual vaginal intercourse and to its management in emergency settings.

Methods: We report a rare case of isolated rectovaginal laceration sparing anal sphincters and perineumin a 24-year-old woman following her second consensual vaginal intercourse with her new partner. Speculum examination demonstrated a 4 cm laceration on the left posterior vaginal wall forming a fistula between the rectum and vagina, 2 cm above the hymenal ring and not extending to the posterior fornix or perineum. Three layer suturing of rectal, vaginal mucosa, and rectovaginal septum was enough to treat the acute fistula in this case.

Results: After 2 months follow-up, we observed the complete healing of the rectovaginal laceration with no fistula formation and the patient resumed her sexual activity. Long term follow-up of patients is necessary to observe complete healing and to ensure the absence of a chronic fistula formation.

Conclusion: Simple suturing of rectal and vaginal mucosa, appropriate antiseptic precautions, and antibiotic coverage are enough to treat acutely formed low rectovaginal fistulas resulting from coitus. Decision to form colostomy and diversion of feces in the repair of such injuries should be taken cautiously.