You know how it works….right?

19 year old female presents to the ED complaining of vaginal pain over the past couple of days. It apparently started suddenly during intercourse with her partner of two months; she finally came into the ED because the pain seemed to be worsening and was increasingly painful during urination.

Her history went something like the following:

Doctor: So are you on birth control?

Patient: No

D: Do you use condoms?

P: No

D: Do you use any protection during intercourse?

P: No

D: Are you trying to get pregnant?

P: No

D: Are you prepared to bring a child into the world at this point in your life?

P: No

D: *blank look*

P: *blank look*

*Insert face palm here.*

Physical exam was normal except for some mild suprapubic tenderness. Vaginal exam revealed a minimal amount of mucusopurulent discharge with a nickel-sized mucoscal ulceration vs possible healing vaginal wall tear on the left side of the vaginal wall about 1.5 cm proximal to the vaginal opening that was concerning for an STD (especially a herpetic lesion) or possible trauma. hCG was negative, no bacterial or yeast infections apparent on laboratory studies. Herpes study was pending when I left. Either she now has a new life-long friend, or this was a freak coital accident. But then, aren’t we all? /sarcasm

Oh yeah…when the chaperoning female tech showed the patient the speculum for the vaginal exam (which, by the way, is phallic in shape but quite small), the patient appeared nervous and said, “I don’t think that’ll fit inside me….”

One can only speculate about what that implies about her poor boyfriend…