Post-coital posterior fornix perforation with peritonitis and haemoperitoneum

Vaginal injuries are common outside of obstetric practice. Post coital posterior fornix perforation and intra-abdominal bleeding is however an uncommon cause for laparotomy.

We present two cases of posterior fornix perforation with hypovolemic shock after sexual intercourse in two young women. In both cases there was a delay in the diagnosis because there was illicit sex. Both women however eventually had laparotomy and uneventful post-operative outcomes.

This is an uncommon condition but it is important to suspect it in sexually active women. Previous reports that it was only found in females with vaginal thinning (children and postmenopausal women) are refuted by these two cases and the importance of interviewing women without a chaperone to get the true story is highlighted for prompt treatment.

Acute post-coital vaginal injuries should be suspected in women who present to hospital with vaginal bleeding and abdominal pain.