Extensive Coital Laceration at a Sexual Debut in a Teenager Presenting at the John F. Kennedy Maternity Center, Liberia

Abstract

We report a case of extensive coital laceration of the posterior vaginal fornix, extending to the lateral wall of the vagina in an 18‑year‑old at coitarche. The patient presented at the emergency department about 10 h after the coital trauma, via a verbal referral from a community health facility where a suspicion of criminal abortion was made, without examination. The patient was concerned about the coital laceration being publicly disclosed, and this resulted in her initial reluctance to divulge information about the incidence. The history at presentation was vaginal bleeding and lower abdominal pains following coital trauma by her boyfriend. Her haemoglobin was 6 g/dl, and shock index was 1.8. She was resuscitated with intravenous fluids and transfused with 3 units of whole blood. Vaginal examination revealed a 4–5 cm posterior fornix laceration which was repaired with vicryl‑1 in the theatre. The patient was offered emergency contraception with levonorgestrel and placed on post‑exposure prophylaxis against human immunodeficiency virus. She was discharged home on the 3rd day with haemoglobin of 9.5 g/dl after counselling. The need to establish trust, confidentiality and a high index of suspicion by healthcare providers especially in young persons with coital injury cannot be overstated as this will facilitate early diagnosis and reduce complications.