Petechial hemorrhages of the soft palate secondary to fellatio

A 25-year-old white woman was evaluated for "spots" on the roof of her mouth of 2 days' duration. The initial history, physical examination, and laboratory data all failed to indicate any cause for the bleeding diathesis. Therefore, a more intensive history was initiated which disclosed a probable case for fellatio as the cause of the spots. The intraoral examination showed the spots to be petechial hemorrhages located on the soft palate in the area of the insertion of the tendons of the tensor veli palatini and levator veli palatini muscles. The mechanism of injury producing these petechiae was postulated to be the combined muscular actions initiated reflexively through tactile stimulation and the negative pressure created through irrumation, both acting simultaneously on the mucosa of the soft palate. This case is presented to illustrate an addition that should be made to the differential etiologic factors of intraoral petechiae.