Air infiltration from the vagina to the abdomen during oral sex, referred to as cunnilingus.
In an extraordinary turn of events, a 29-year-old woman has recovered from a rare and potentially life-threatening condition, pneumoperitoneum, which was caused by an unconventional route - sexual activity. The patient's improvement enabled her to return home without complications, marking a successful outcome in a case that underscores the importance of understanding this unusual complication.
The first recorded instance of pneumoperitoneum due to sexual activity was reported in 1980, and since then, sporadic cases have been documented in medical literature. Dr. Édouard Marque, in his 1875 medical thesis, first suggested the possibility of air passage through the genital tract, although the connection to pneumoperitoneum was not fully realized until much later.
Pneumoperitoneum, the presence of air or gas in the peritoneal cavity, is most commonly associated with perforations of the gastrointestinal tract or as a result of medical procedures. However, in rare cases, it can arise from non-medical causes, such as sexual activity.
In the reported case, the patient underwent a right salpingo-oophorectomy by laparoscopy for an ectopic pregnancy. Seven days later, she returned to the emergency room with severe abdominal pain and distension, revealing a pneumoperitoneum. The literature emphasizes the importance of targeted questioning about potential sexual activity to identify the cause of air presence in the peritoneal cavity.
The mechanism behind pneumoperitoneum caused by sexual activity is not fully understood, but it is thought to result from barotrauma (pressure changes), trauma to abdominal or pelvic organs, or the introduction of air through the urogenital tract during activity. In this case, the patient's history revealed that she had sexual intercourse involving prolonged cunnilingus and the use of a sex toy delivering air pulsations on the day of her symptoms.
Air introduced during sexual intercourse could potentially pass through unhealed vaginal stump lacerations and reach the peritoneal cavity. Pneumoperitoneum has been reported in patients shortly after childbirth and in those with a history of gynecological surgery, notably hysterectomy.
Management of pneumoperitoneum caused by sexual activity is generally conservative in cases without signs of infection or peritonitis, but surgical intervention may be required if a perforation is suspected. In the reported case, an abdominal-pelvic CT scan revealed a large amount of free air in the peritoneal cavity, indicating the need for further investigation and potential surgical intervention.
While pneumoperitoneum caused by sexual activity is a rare event, clinicians should consider it as a possible cause in patients presenting with pneumoperitoneum and a relevant history, especially when other common causes have been excluded. Further research and detailed case reports are needed to better understand the mechanisms and optimal management strategies for this phenomenon.
In the context of unconventional causes of pneumoperitoneum, it's worth noting that science has documented sporadic cases where this condition was triggered by sexual activity, as seen in the 1980s and more recently, as evidenced by the case study. This unusual complication underscores the importance of health-and-wellness conversations addressing sexual-health and women's-health aspects, including the potential risks associated with air introduction during sexual activities that involve certain methods or devices.
