Vaginal Foreign Body Evaluation and Treatment

Excerpt

Vaginal foreign bodies present in female patients of all ages and a wide range of healthcare settings, including the emergency department, primary care office, gynecology office, and urology office. The objects found differ among age groups. Toys, tissue paper, and household objects are the most common in pediatrics. In adult women, considerations include tampons, condoms, menstrual cups, and items used for sexual gratification. Elderly patients are at increased risk for retained medical devices such as pessaries. Patient populations such as prisoners and drug traffickers may use the vaginal canal and uterus to hide illicit substances. In postpartum patients with recurrent abdominal pain, pelvic abscess, bladder stones, irritable bladder, and retained surgical gauze merit consideration; however, this is an unusual complication due to patient safety initiatives involving the careful counting of surgical gauze and sponges during delivery.

Patients may self-report a foreign body or may present with an array of symptoms, including pelvic pain, vaginal discharge, and vaginal bleeding. There is a broad differential diagnosis for these symptoms, including malignancy, sexually transmitted infections, candidal infections, and pregnancy. The most common presenting symptom in pediatric patients is vaginal bleeding or discharge.

When evaluating a patient who suspects a vaginal foreign body, history should focus on the details surrounding the initial event; this includes timing, the suspected object, and symptoms of the abdomen, pelvis, and genitalia. History taking is imperative in all patient populations. Even in pediatric patients, the majority, 54% in one study, recall the event. It is essential to consider sexual abuse as a cause for foreign bodies, especially in the pediatric population.