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LETTER TO EDITOR
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 31-32

Cusco's speculum-induced iatrogenic deep vaginal wall laceration in a peri-menopausal woman – An unusual case report


Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India

Date of Submission05-Feb-2022
Date of Acceptance05-May-2022
Date of Web Publication12-Nov-2022

Correspondence Address:
Dr. Vijayan Sharmila
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_5_22

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How to cite this article:
Sharmila V, Kavitha G. Cusco's speculum-induced iatrogenic deep vaginal wall laceration in a peri-menopausal woman – An unusual case report. J Patient Saf Infect Control 2022;10:31-2

How to cite this URL:
Sharmila V, Kavitha G. Cusco's speculum-induced iatrogenic deep vaginal wall laceration in a peri-menopausal woman – An unusual case report. J Patient Saf Infect Control [serial online] 2022 [cited 2022 Dec 6];10:31-2. Available from: https://www.jpsiconline.com/text.asp?2022/10/1/31/361008



Sir,

Vaginal lacerations or tears may occur due to obstetric and non-obstetric causes. Non-obstetric vaginal injuries differ greatly from lacerations sustained during childbirth and the aetiological factors include virginity, insertion of foreign bodies into the vagina, vigorous thrusting of the penis during intercourse, sexual assault, atrophic vagina in post-menopausal women, friability of tissues, stenosis and scarring of the vagina due to congenital abnormalities, previous surgeries and pelvic radiation therapy.[1] Minor lacerations usually resolve with minimal treatment. Deeper lacerations often result in significant vaginal bleeding warranting immediate intervention.[2],[3] Post-coital vaginal laceration is a well-known entity to gynaecologists. However, iatrogenic deep vaginal laceration following vaginal speculum examination has not been reported in the literature so far.

A 50-year-old multiparous peri-menopausal woman presented with history of discharge per vaginum and vaginal dryness. Her menstrual cycles were regular and she was not sexually active. Her general, systemic and abdominal examination were normal. External genitalia was healthy, and Sim's speculum examination revealed dry vagina, no abnormal discharge, no puckering or fibrosed areas, and the cervix could not be visualised. Examination of the cervix was attempted by insertion of Cusco's bivalve self-retaining vaginal speculum, following which a sudden gush of fresh blood was noted at the introitus that seemed to be very unusual. Examination revealed a 3-cm vaginal laceration with a depth of 1 cm, high up in the left lateral vaginal wall with normal cervix. The bleeding could not be controlled with pressure packing and required sutured under anaesthesia. Post-operative period was uneventful.

It has been reported that up to 75% of women with vaginal lacerations may need repair and 15% of cases may present with haemorrhagic shock.[1] Important factors predisposing to vaginal tears in peri- and post-menopausal women include thinning of vaginal tissue due to ageing, vaginal dryness and associated oestrogen deficiency. In our case, deep vaginal wall laceration occurred in a peri-menopausal woman following speculum examination, probably due to vaginal dryness. We should be cautious while performing speculum examination in peri- and post-menopausal women and in those with prolonged periods of sexual abstinence where there is decreased lubrication. In such cases, a standard practice of care will be to use a small-sized speculum along with the application of small amount of water-based lubricating gel while performing speculum examination.[4] These measures can help prevent iatrogenic vaginal injuries and reduce the patient discomfort during speculum examination.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Manohar R, Kavyashree G. Post coital vaginal tear – A rare life threatening emergency. J Evol Med Dent Sci 2013;2:7637-9.  Back to cited text no. 1
    
2.
Sloin MM, Karimian M, Ilbeigi P. Nonobstetric lacerations of the vagina. J Am Osteopath Assoc 2006;106:271-3.  Back to cited text no. 2
    
3.
Austin JM, Cooksey CM, Minikel LL, Zaritsky EF. Postcoital vaginal rupture in a young woman with no prior pelvic surgery. J Sex Med 2013;10:2121-4.  Back to cited text no. 3
    
4.
Hoyo C, Yarnall KS, Skinner CS, Moorman PG, Sellers D, Reid L. Pain predicts non-adherence to pap smear screening among middle-aged African American women. Prev Med 2005;41:439-45.  Back to cited text no. 4
    




 

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