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Prominent metalware from pelvic surgery causing dyspareunia.
Mithun Nambiar1, Samuel Raymond Heaton1, Andrew John Stevenson1
1Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
BMJ Case Reports
|January 8, 2017
Summary
A rare cause of painful intercourse in women was identified as misplaced surgical screws after pelvic surgery. Removing the screws resolved vaginal pain, though hip pain from the original injury persists.
Area of Science:
- Orthopedic Surgery
- Gynecology
- Trauma Surgery
Background:
- Pelvic fractures from motor vehicle accidents often require extensive surgical repair with internal fixation.
- Postoperative complications can include hardware malposition leading to secondary symptoms.
Observation:
- A female patient experienced dyspareunia (painful intercourse) following pelvic surgery.
- Vaginal examination revealed a palpable screw tip causing mechanical irritation of the anterior vaginal wall.
Findings:
- X-ray imaging confirmed that long screws from an anterior column plate were impinging on the anterior vaginal wall.
- Percutaneous removal of the offending screws completely resolved the patient's dyspareunia.
Implications:
- This case highlights the importance of meticulous surgical technique and hardware placement in pelvic reconstruction.
- Awareness of potential genitourinary complications from orthopedic hardware is crucial for patient management.
- While mechanical causes of dyspareunia can be addressed surgically, residual pain from the initial trauma may require further management.