8.04 Vaginal Foreign Bodies

agk’s Library of Common Simple Emergencies

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.

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