Vaginal mucosal necrosis following traditional vaginal cauterization in Somalia: a case report

Traditional vaginal cauterization is practiced in some low-resource settings, including Somalia, for gynecological complaints. Unregulated thermal exposure may cause severe tissue destruction. Circumferential full-thickness vaginal necrosis requiring reconstruction is extremely rare. A 70-year-old multiparous Somali woman presented with severe vaginal pain, foul discharge, fever, and urinary retention 14 days after cauterization. Examination revealed stage IV pelvic organ prolapse and circumferential full-thickness vaginal necrosis extending to within 1 cm of the urethral meatus. Laboratory tests showed leukocytosis (12 400/mm³), elevated C-reactive protein (46 mg/L), and creatinine 1.3 mg/dL. Intravenous antibiotics were initiated. Wound culture grew Klebsiella spp. susceptible to gentamicin, and therapy was adjusted. Surgical debridement followed by colpocleisis was performed. Recovery was uneventful. Traditional vaginal cauterization may cause devastating thermal injury requiring radical surgery. Early recognition and multidisciplinary management are essential. Preventive public health measures are urgently needed.