Background: Vaginal cuff dehiscence is an uncommon but serious complication of hysterectomy. It has not previously been described in the setting of systemic lupus erythematosus (SLE) and total laparoscopic hysterectomy (TLH).
Case: A 43-year-old woman with SLE presented to the emergency department >7 weeks after TLH with severe abdominal pain resulting from a postoperative intercourse attempt. Examination under anesthesia revealed complete separation of the anterior and posterior vaginal cuff edges.
Conclusion: A patient's medical profile, including comorbidities that affect wound healing, plays a role in vaginal cuff integrity after hysterectomy. For patients with SLE undergoing TLH, temporarily stopping immunosuppressive medications for several weeks preoperatively and postoperatively and allowing prolonged recovery with pelvic rest may improve postoperative outcomes.