Vaginal Foreign Bodies

8.04 Vaginal Foreign Bodies

Presentation
This commonly is a problem of children, who may insert a foreign body and not tell their parents. The patient is finally brought to the emergency department with a foul-smelling purulent discharge with or without vaginal bleeding. Vaginal foreign bodies in the adult may be a result of a psychiatric disorder or unusual sexual practices. Occasionally a tampon or pessary is forgotten or lost and causes discomfort and a vaginal discharge.
What to do:



Visualize the foreign body using a nasal speculum in the pediatric patient or a vaginal speculum in the adult.



Pediatric patients may be placed in the knee-chest position and, while performing a rectal examination, you may be able to expell the foreign body from the vagina by pushing with the examining finger in the rectum.



Friable foreign bodies such as wads of toilet paper may be flushed out using warm water, an infant feeding tube, and a standard syringe.



Lost or fogotten tampons can be removed with vaginal forceps that are first pierced through the finger of a latex glove, so that when the malodorous foreign body is extracted, the glove can immediately pulled over it to reduce the odor before it is discarded in a sealed plastic bag. The vagina should then be swabbed with a betadine solution.



In difficult cases, or when large or sharp obects are involved, young and adult patients may require general anesthesia to allow removal under direct vision.



When general anesthesia is not required, conscious sedation should be considered.



The patient should empty her bladder and lie in stirrups in the lithotomy position. Insert a Foley catheter to break any suction between the foreign body and the vaginal mucosa. Most objects can then be grasped with ring forceps or the plaster and tongue blade method.



Reserve x rays for radio-opaque foreign bodies concealed in the bladder or urethra. Objects in the vagina are usually apparent on examination. What not to do:



Do not ignore a vaginal discharge in a pediatric patient or assume it is the result of a benign vaginitis. Perform a bimanual or rectoabdominal examination to palpate a hard object and then do a gentle speculum exam to look for a foreign body or signs of vaginal trauma.



Do not forget to ask about possible sexual abuse and consult with protective services if it cannot be ruled out.
Discussion
Vaginal foreign body removal is generally not a problem, but when large objects make removal more difficult, use the additional techniques described for rectal foreign bodies.