Deeper Into Circumcision: An Invitation to Awareness

Vulvo-Rectal Fistula

From Violence During First Coition

The patient, a young woman of 22 years, presented herself at the gynecological clinic of the Philadelphia Dispensary, with the following history: Previous to her marriage, which took place eighteen months ago, she had been a perfectly healthy woman. From the first attempt at sexual intercourse with her husband, which caused her to suffer such acute pain that she almost fainted, she dates all her trouble. The sexual act was also followed by severe haemorrhage, which persisted for a month; the passage of faeces and flatus per vulvam was at once noticed. Every repetition of the sexual act for the next two or three weeks was followed by renewed bleeding, and even at the present time she suffers severely during intercourse. The passage of the faecal matter through the vulva gradually increased in degree until the rectum was evacuated entirely through the vulva. There has been an entire inability to retain flatus and faeces. Examination: The finger on entering the vulva passes at once into the rectum through a patulous opening of sufficient size to admit two fingers. Inspection shows a perfectly intact crescentic hymen of moderate thickness and rigidity, having a small anterior opening. Immediately in front of its posterior attachment is an irregular transverse tear, an inch and a half in its longest diameter, with thickened and everted edges, extending backwards and upwards for about one and one-half inches, exposing to view the mucous membrane of the bowel. The vagina is small and has evidently never been entered ... The case here reported is of especial interest from the fact that the traumatism undoubtedly occurred during first coition; from the virginal condition of the hymen and from the long time during which sexual relations were maintained under conditions which must have been disagreeable to both husband and wife ...

But for the fact that the husband had been deprived of his prepuce in infancy, thereby rendering the penis callous by the exposure of the glans to the air, it is hardly possible that he could have forced the organ through the flesh as he did, without so much personal suffering as to compel him to desist.

Journal of the American Medical Association,
vol. 6, no. 23 (June 5, 1886): pp. 638-639

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