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Objective
(1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries.Methods
We present a case series of 4 female adolescent patients seen at a children's hospital over a period of 6 months. Each patient developed significant vaginal bleeding after sexual intercourse, and 3 of the patients presented to the emergency department with vital signs consistent with compensated shock.Results
Each patient was evaluated by pediatric surgery, and found to have a laceration of the vagina. Three of the patients described consensual intercourse prior to the onset of bleeding, and had lacerations of the vaginal fornices; these patients were determined to have injuries resulting from consensual sexual intercourse. The fourth patient reported sexual assault as the cause of her injuries, and was treated for longitudinal lacerations of the vaginal wall.Conclusions
Lacerations of the upper vagina are not frequently reported in forced vaginal intercourse, but are occasionally reported as injuries sustained during consensual coitus. In the absence of reported sexual assault, a severe vaginal fornix laceration is consistent with the diagnosis of coital injury from consensual intercourse. Diagnosis and treatment of this injury can be delayed due to the sensitive nature of these injuries. Bleeding can be profuse, leading to hemorrhagic shock, and these injuries may require transfusion of blood products and surgical repair in some cases. Complications may include hemoperitoneum, pneumoperitoneum, or retroperitoneal hematoma, even in the absence of complete vaginal perforation.Practice implications
Knowledge of the consensual sexual injuries that may occur in adolescent patients can guide diagnosis, treatment, and counseling for the patient and her family, preventing long-term medical complications and legal consequences. 相似文献2.
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Thane Chambers 《Medical Library and Historical Journal》2008,96(4):392-394
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Pigeons categorized binomial samples. One of two “coins” was tossed on each trial, and birds learned to infer from observing the outcomes which of the two equally likely coins had been tossed. Outcomes (“heads” or “tails”) appeared as successively presented red or green center keys. Coin R was biased in favor of red, and coin G was similarly biased in favor of green. A categorization consisted of a choice of a left or right side key and was reinforced with food if it was to the key (left for coin R and right for coin G) corresponding to the coin that produced that trial’s sample. Coin bias and minimum sample size required for reinforcement were experimentally manipulated. When sample size was greatest (n=8), categorizing a sample as having been produced by coin R tended to undermatch the probability that the sample was produced by coin R. When sample size was smallest (n=1), categorizing a sample overmatched, provided that the context did not include other trials with large samples. This context effect reconciles an otherwise inconsistent literature on intuitive statistical inference in pigeons but suggests a new and difficult goal for research-the general clarification of the effects of sampling context on inference. 相似文献
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