Vaginal tear are traumatic injuries to the walls of the vagina that occur during childbirth or during sexual intercourse. The main manifestations include acute pain, bleeding from the genitals, an increase in the size of the labia, a feeling of heaviness and swelling in the pelvic area. The combinations and severity of clinical signs depend on the severity of vaginal rupture and its localization. Diagnosis is based on anamnesis data, symptoms and results of visual examination of the female genital tract. The tactics of treating vaginal tear are determined taking into account the depth of the injury. Massive hematomas and pronounced ruptures of the walls require surgical intervention with suturing of the wound or drainage of the hematoma.
General information
Vaginal tear are a pathological condition in obstetrics and gynecology, which is characterized by damage to the walls of the vagina, accompanied by pain syndrome, bleeding or the formation of hematomas. Damage to the upper and lower third of the organ is most often observed. This is due to the fact that a vaginal rupture often occurs against the background of a rupture of the uterus or perineum. Isolated injuries and ruptures of the middle third are less common, since this area has a relatively greater elasticity and is less connected to the surrounding tissues. Most cases of vaginal tear are classified as violent. Most often, obstetric pathologies or rough sexual acts act as etiological factors.
Causes
Vaginal tear can be provoked by the non-physiological position of a woman’s body during intimacy, excessively aggressive or violent sexual intercourse, inadequate condition of sexual partners (alcohol, drug intoxication), rough use of foreign bodies or intimate accessories in order to obtain sexual pleasure. Also, vaginal tear can occur with severe injuries to the pelvic area, combined with ruptures of the uterus or perineum during childbirth. In the latter case, they may be the result of the use of obstetric aids, incorrect birth tactics of an obstetrician-gynecologist, anatomical and physiological characteristics of the mother and fetus, mismatch of the size of the genital tract and the child’s part. All of the above cases are considered violent ruptures of the perineum.
There are also arbitrary ruptures that occur during normal sexual intercourse or physiological childbirth due to the low elasticity of the tissues of the genital tract. Predisposing factors that increase the likelihood of developing such injuries include previously suffered vaginal tear and the presence of scars, colpitis, infantilism, first childbirth over the age of 35.
Symptoms
Clinical manifestations of vaginal rupture depend on the severity and localization of the injury. There are no specific symptoms of this condition. In most cases, birth ruptures of the vagina are combined with ruptures of the uterus or perineum, which determine the clinical picture. Small ruptures can occur without any clinical manifestations. The primary symptom of pronounced vaginal tear is acute pain in the genital area, the intensity of which depends on the depth of the damage. Sometimes there may be an increase in body temperature to subfebrile figures. Also, a sign of vaginal rupture is bleeding from the genital tract, which occurs when the integrity of the mucous membrane is violated. The degree of blood loss depends on the localization of damage to the vagina or perineum: with a rupture in the clitoris, profuse bleeding is detected, and with traumatization of the arches – moderate.
If the walls of the vagina are damaged during natural childbirth, bleeding develops during the labor period or after the birth of the child. With vaginal tear that are localized in the submucosal ball and are characterized by damage to the venous or arterial vessel, the leading symptom becomes a hematoma of the genital tract. Visually, it is manifested by the protrusion of the vaginal wall, an increase in the size of the labia majora or labia minora from the side of the lesion, sometimes with the addition of cyanosis. At the same time, a woman may experience a feeling of bursting and heaviness in the perineum area.
As a rule, with modern medical care, complications are not observed. The most common undesirable consequences of vaginal rupture include massive blood loss, vaginal-rectal or vaginal-bladder fistulas, as well as infectious complications.
Diagnosis and treatment
Diagnosis of vaginal tear is based on the collection of anamnesis and complaints of the patient, an objective examination and the results of laboratory tests. As a rule, anamnesis data and an objective examination of the genital tract are sufficient for diagnosis. From anamnestic information, aggressive or violent sexual acts, polytrauma, the use of obstetric aids during childbirth, as well as concomitant ruptures of the uterus or perineum may indicate damage to the vagina. Visual examination of the external genitalia may determine the increase in size and cyanosis of the labia, bleeding from the vaginal cavity.
During vaginal examination, signs of vaginal tear are mucosal defects or protrusion of the wall corresponding to submucosal hematoma. In cases of vaginal tear in its distal third and the area of transition to the arch, a manual examination of the uterus is performed to exclude ruptures of its lower segments. Laboratory data, as a rule, are uninformative, especially in the presence of minor vaginal tear. In a general blood test with massive blood loss, signs of hemorrhagic anemia (a drop in hemoglobin and erythrocytes) can be determined, and with the development of inflammatory complications, neutrophilic leukocytosis and an increase in ESR.
Therapeutic tactics for vaginal tear depends on the nature and massiveness of the damage. With minor submucosal hematomas, medical intervention is often not required – hemorrhages resolve on their own. Small ruptures of the walls that do not cause clinical manifestations also heal on their own. With more massive hematomas or pronounced ruptures of the walls, surgical intervention is required. The main methods of anesthesia are epidural anesthesia or intravenous anesthesia. Massive hematomas are opened and emptied, hemostasis of damaged arterial or venous vessels is performed. Large vaginal tears accompanied by bleeding are sutured with separate sutures or a continuous catgut suture. Also in such cases, in order to prevent infection of the wound, antibacterial drugs are prescribed to the woman.
Prognosis and prevention
The prognosis for isolated vaginal tear is favorable. When combined with a rupture of the uterus or perineum, the outcome depends on the overall severity of damage to the genitals. With timely medical care, complications are not observed. The issue of planning a child is decided individually with the attending obstetrician-gynecologist. In most cases, an isolated vaginal rupture is not a contraindication to pregnancy.
Prevention of vaginal tear implies the exclusion of all potential etiological factors (promiscuous sexual intercourse, excessive aggression during sexual intercourse, etc.), the correct use of intimate accessories. To prevent vaginal ruptures that occur as complications of perineal or uterine ruptures, measures are needed to prevent the underlying pathology. This includes timely registration in a women’s consultation, examination of the mother’s genital tract, study of the anatomical and physiological characteristics of the fetus, rational choice of the method of delivery, etc.
