- 期刊
初次性交致嚴重陰道裂傷及出血性休克－個案報告
The Occurance of the Vaginal Laceration and Hemorrhagic Shock during Consensual Coitarche-Case Report
摘要
性交所導致的生殖器傷害，在女性並不罕見，尤其是發生在初次或是較少性經驗的婦女。依據文獻上報告的案例，自願性跟非自願性（強暴）性行為所導致的撕裂傷，發生的部位型態並不盡然相同。我們在急診室碰到兩個案例，都是成年女性但未曾有過性經驗，在非受迫性初次的性行為中，發生陰道大量出血的情形。第一例病患因為輾轉運送，至本院時瀕臨休克；而第二例則順利救治。同時，我們發現兩例都是發生在陰道後側以及右側穹窿。綜合許多研究報告，我們推測在非受迫性的性行為中，可能在性行為進行時，子宮因為向右旋轉的光天解剖特性，加上性交過程中陰道穹窿受陰莖作用，會極度伸展，造成裂傷容易發生在右側及後側。在非陰道的傷害，也是會有相同的情形。我們可以很清楚看出，即時診斷是減少病患傷害的不二法門。只要即時診斷，傷害的處理只需要簡單的技巧。但是對於病患往後性心理的衝擊，是臨床醫師需要多加以注意的。然而，性教育某方面的盲點，以及往後對於性功能的衝擊，恐怕是最需要持續注意以及省思的。
並列摘要
Coital injury causing severe vaginal laceration was not rare during the first coitus or for those women who rarely had sexual experience. The type and prevalent sites of coital genital injury were not the same between consensual and non-consensual coitus. In this report, were the patients, two female adults, 30 year-old and 20 year-old respectively, Severe vagina laceration and bleeding occurred during the process of consensual coitarche. They both had sexual intercourse with missionary position, and did not use any sex toy. Both of them were transferred to the hospital immediately. However, because the first case did not receive prompt management, she suffered impending shock when being transferred to our hospital. The other case was managed immediately after she arrived at our emergency room, and received excellent outcome after primary repair of vaginal laceration. We found the lacerated sites were located at posterior and right fornices in both cases. The cases reported in literature indicated that most of the coital vaginal laceration occurred on the posterior and right fornices. According to the descriptions of some related articles, we postulated that the vaginal laceration on these vulnerable sites may be due to the dextro-rotation characteristics of uterus and the distensibility of vagina in this area. One study also indicated that the vaginal fornix can be extremely distended during sexual intercourse that makes it vulnerable to laceration in this area. For those cases of coital injury without vaginal lesions, there was also prevalence at right side. It is critical that such coital injury needs prompt judgment to provide a prompt management. It needs only simple surgical skills to cure the injury if only the vital signs are stable. However, those victims may need further psychological counseling to prevent them from negative impact to their sexual functioning in the future.