Vaginal foreign body

Background

• Patients may be reluctant to provide history due to fear or embarrassment
• Foreign bodies most commonly found to be:
  • Retained tampon
  • Sex toys or other items used for sexual stimulation
  • Packets of drugs
  • Toilet paper
  • Pieces of cloth or small toys (in young girls)

Clinical Features

• Vaginal discharge, chronic
  • Often malodorous
  • Consider foreign body in all prepubertal patients with discharge, especially if bloody or brown
• Vaginal bleeding
• Vulvovaginitis
• Pelvic pain

Differential Diagnosis

• Infection
  • Bacterial Vaginosis, Trichomonas, chlamydia/gonorrhea infection, Candida Vaginitis
  • Endometritis, PID, TOA
• Ob/gyn conditions
  • Ectopic pregnancy, abortion (threatened, incomplete, or septic)
  • Pelvic thrombophlebitis
  • Ovarian torsion, ovarian cyst hemorrhage/rupture
  • Dysmenorrhea, endometriosis
• Genitourinary
  • Cystitis, Pyelonephritis
  • Renal colic
• Gastrointestinal
  • Appendicitis, SBO, mesenteric ischemia, hernia
  • Anorectal abscess
  • Diverticulitis, Inflammatory bowel disease

Evaluation

• Visualization may be aided by irrigation with normal saline
• Children <7yo or uncooperative patients may require vaginoscopy in the OR with anesthesia
• Plain films sometimes help identify radiopaque objects
• Some items may be identifiable on ultrasound or MRI

Management

• Remove object, either manually or with saline irrigation