Nonobstetric lacerations of the vaginal wall or introitus are most often the result of sexual trauma (consensual or otherwise). This may occur from intercourse (80%), saddle or water-skiing injury, sexual assault, or penetration by foreign objects. A rape injury, in particular, may be a potentially serious one, because it is often associated with psychological trauma (rape trauma syndrome), damage to adjacent vital organs, and even surgical shock. This is especially true when the injury occurs in a child. Inspection of the vestibule and vagina in such a case often reveals a jagged laceration, which has ruptured the hymen, torn the labia minora, and extended down the perineum toward the anus. Usually, the external genitalia are also badly damaged, with contusions and abrasions as far as the medial surfaces of the thighs. In more severely traumatized victims, the tears may compromise the integrity of the urethra, bladder, and rectum or breach the peritoneum. Such individuals may be brought into the hospital in a state of profound shock requiring immediate blood and ﬂuid replacement before deﬁnitive surgical treatment can be instituted. In adults, common sites of lacerations are the vaginal wall, the lateral fornices, and the cul-de-sac. Rape injuries are dangerous in elderly, postmenopausal women who, because of vulvar and vaginal atrophy and the attendant increased fragility of the vaginal wall, are predisposed to more extensive damage. In younger women, the trauma to the vagina from rape is usually not so grave, although during pregnancy and in the immediate post-partum period, the tissues are vascular, delicate, and liable to injury.