Case Series of Three Postcoital Rectovaginal Fistulae

Abstract

Abstract

Background: Sex is a basic human need, and consensual vaginal coitus is a physiologic act. It normally does not lead to any significant trauma except for minor hymenal or vaginal tears sustained during vaginal penetration for the first time. The literature shows some reports of major vulval hematomas, vaginal lacerations, ruptured ectopic pregnancies, ovarian cysts, and even hemoperitoneums. Yet, no reports of rectovaginal fistulae (RVF) following consensual coitus was found in the literature. RVF can be caused by obstetric injuries, surgical complications, malignancies, or infections. It may also follow nonconsensual vaginal intercourse, but it is hard to imagine and rare to see RVF following normal consensual coital acts. Cases: This article hereby presents cases of 3 married women in whom normal consensual coital acts with their husbands led to rectovaginal fistulae. None of the women had any history suggestive of instrumentation or infection. It was the first coital act after marriage for 2 of the women but the third woman had been married for 9 years and had 2 children. Results: All 3 patients became continent of flatus and feces after surgical repair. Conclusions: Normal consensual coital acts may lead to rectovaginal fistulae in women with tight introitus or vaginismus. Clinicians should make thorough examinations when women present with bleeding and discharge following consensual coitus, to exclude the presence of rectovaginal fistulae. (J GYNECOL SURG: 29:70)