Foreign Body, Vagina

Common symptoms of a vaginal foreign body include vaginal discharge, bleeding, itching, vulvar discomfort, and pelvic pain.

• Some objects are designed for use in a woman's vagina. These include tampons, vaginal suppositories, and medications delivered through the vagina. Others are not intended to be inserted and may be placed there accidentally or intentionally. Doctors refer to objects found in the vagina as "foreign bodies." These foreign bodies may produce symptoms or be asymptomatic for long periods.
• Small objects inserted into the vagina do not generally cause pain. Unusual objects, generally those larger than the customary vaginal diameter or size of the vaginal entrance (introitus), may cause pain because of distention. Other objects may cause pain due to sharp edges.
• Vaginal foreign bodies are more commonly seen in children than in adult women. Adolescent girls may seek medical care with foreign bodies in the vagina, which primarily consist of forgotten tampons or broken portions of condoms. Adults may also seek medical care with vaginal foreign objects, which may have been placed there intentionally as part of a sexual encounter or placed as part of an episode of abuse.
• While a variety of symptoms may result from a foreign body in the vagina, the most common symptoms are vaginal bleeding or foul-smelling vaginal discharge. Less common symptoms may include pain with urination (dysuria), or pelvic pressure.
• Rarely do foreign bodies produce a systemic infection (an infection that spreads throughout the body through the bloodstream) except in circumstances such as severe compromise of the immune system or disruption of the vaginal wall with secondary infection. Perforation through the vagina into the abdominal cavity may also result in acute abdominal symptoms.
• Chronic consequences of vaginal foreign bodies include the embedding of objects in the vaginal wall, pain with intercourse, bleeding, or the development of fistulae (abnormal openings or connections) between the vagina and the bladder, rectum, or peritoneal (abdominal) cavity.

The most common foreign body of the vagina in small children is small amounts of fibrous material from clothing, carpets, etc. Other foreign objects found in the vagina in children may be placed there at a time of self-exploration. They may be forgotten, or once placed in the vagina, unable to be removed by the child. Other common objects include marker caps or crayons. The objects found in children generally are small and do not cause pain from distension of the hymen or vaginal opening at the time of placement. Children will generally not place objects larger than the vaginal entrance due to discomfort.

Adolescent women may use tampons once they begin menstruating. Occasionally, these tampons are forgotten and may not be removed for days. The breakage of a condom may also result in bits of latex or non-latex material being left in the vaginal vault.

Adults may place foreign objects into the vagina as part of a sexual experience or for sexual stimulation. Less commonly, unusual objects may be placed in the vagina as the result of abuse. Adults may also experience forgotten tampons or bits of a condom.

While small objects placed in the vagina may remain asymptomatic for a period of time, larger objects may produce pain or discomfort immediately, thus precipitating a visit to a health care professional.

Occasionally a foreign body may be left inadvertently in the vagina because of altered mental status. Those psychiatric conditions most often associated with this event include altered consciousness from alcohol or drugs, dementia, schizophrenia, or self-injurious behaviors. Caustic substances - chemicals, batteries - may result in chemical burns to the vaginal tissue with secondary scarring (strictures) or altered vaginal dimensions.

Rarely, anatomical abnormalities of the vagina such as a vaginal septum (a wall of tissue that separates the vagina into two sections) or septum of the hymen (extra hymeneal tissue that runs vertically to a normal hymen) may allow an object (such as a tampon) to be placed into the vagina, but not easily removed.

Objects may be placed in the vagina and enhance the sexual pleasure of the patient or her partner. Occasionally these may be unable to be removed by the patient or her partner (for example, marbles, and beads).

Common symptoms of a vaginal foreign body include the following:

• Vaginal discharge, generally foul-smelling and yellow, pink, or brown
• Vaginal bleeding, especially light bleeding
• Vaginal itching or foul odor
• Urinary symptoms such as discomfort with urination (dysuria)
• Vulvar discomfort due to vaginal discharge producing skin irritation
• Abdominal or pelvic pain from placement of large objects or perforation of a foreign body into the peritoneal cavity

Symptoms accompanying the presence of a foreign body include the following:

• Skin redness (erythema)
• Swelling of the vagina and entrance to the vagina
• Rash in the vaginal area

Symptoms associated with chronic foreign body placement in the vagina or complications of chronic foreign body placement (such as fistulae) include disorders of urination or bowel function, loss of bladder control (incontinence), or abnormal bowel function. Moreover, blood in the urine or stool can result from these complications. Larger objects may obstruct urination. Foreign bodies that perforate the vagina may also result in serious systemic symptoms such as abdominal pain, distortion, fever, or signs of serious infection (sepsis).

Pressure from the presence of the foreign body against the vaginal walls and adjacent structures (such as the bladder) causes the tissue to be compromised and allows perforation or fistulization.

The presence of a vaginal foreign body may alter the normal bacterial flora of the vagina, thus resulting in repeated efforts to treat "vaginitis." The symptoms of a vaginal discharge may be interpreted as vaginitis, a sexually transmitted infection, or yeast infection by the patient or unaware health care professional. Repeated use of antibiotics or other medications will not "cure" the symptoms if a foreign body remains in the vagina.

Objects left in the vagina very rarely lead to serious complications. However, the medical literature has had several case reports of pelvic abscess and subsequent scarring as a result of foreign bodies in the vagina.

A health care professional should be consulted when any change in vaginal discharge is present, particularly discharge which is foul-smelling or abnormal in color. The presence of a foreign body may cause abnormal vaginal bleeding.

If a foreign object was placed in the vagina and may still be present, the health care professional should be informed. Occasionally, an adult or adolescent woman may remember placing a tampon, but then be unable to remove it from the vagina. Recollection of the placement of a foreign body may assist the practitioner in the best method of care.

If a person places an object in the vagina and then is unable to remove it, a health care professional should be consulted promptly. Unusual objects may need to be removed using sedation or anesthesia in order to avoid pain. This may be particularly true of objects placed in the vagina of a small child or an adult who is unable to be cooperative with a vaginal exam. Some emergency departments allow sedation and removal of vaginal foreign bodies in the emergency department without going to an operating room.

Vaginal foreign bodies are seen more commonly in children than in adolescent or adult women. Children may not be able to supply the history of an object placed in the vagina; however, some children will say that they have "lost an object in their vagina." In addition to obtaining specific information about a possible vaginal foreign body, a health care professional will perform a general history and physical examination.

It is appropriate for the health care professional to ask questions related to sexual activity and sexual or physical abuse.

Methods for diagnosing and retrieving foreign bodies depend on the age of the female patient and sometimes the duration of time the object has been in the vagina.

For young girls, any visit to a doctor's office can be frightening. If a foreign object is suspected in a young girl, the physician may gently examine the vulva and vaginal entrance by separating the labia and glimpsing the foreign object. This may allow removal in the office through such techniques as warm water lavage of the vagina, but other larger objects may require sedation or examination under anesthesia for removal.

An adolescent patient may easily have a foreign body removed from the vagina in the outpatient setting. This may also hold true for adults. Visualization of the foreign body using a speculum and removal with forceps may be the most efficient treatment.

• Unusual objects or those that may disrupt the vaginal wall may require sedation or anesthesia for removal, and to complete a thorough exam of the vagina and cervix.
• A rectal exam in addition to a vaginal exam may be required to find the presence or location of a foreign body.
• If an object has been present in the vagina for a long time, that object may cause erosion into the wall of the vagina. Acute placement of an unusual object in the vagina may cause perforation of the vaginal wall and secondary symptoms of intra-abdominal infection. (For example, an unusual case report in the emergency medicine literature revealed the placement of wood sticks in the vagina of an adult female 2 years before she began having pain in her hips. The sticks had been inserted in order to attempt to terminate a pregnancy. The sticks, however, remained in the vagina and eventually migrated through the vaginal wall to produce hip pain.)
• Although examination generally reveals the presence of a foreign body, some imaging techniques may also be helpful. These may include a CT (computerized tomography) scan, an MRI scan, or an abdominal X-ray. Ultrasonography may also assist in the location of a foreign body in the vagina or pelvis.

The best management of a foreign body is removal. This is generally the only treatment necessary.

Some patients may be able to remove the foreign body themselves by simply placing their finger in the vagina, locating it, and removing it. Other objects may need to be removed by a health care professional.

Bacterial infections or alteration in the normal bacterial flora of the vagina may be due to the presence of a foreign body altering the usual acidic environment of the vagina. Removal may be performed with forceps or with warm water irrigation of the vagina. Once the foreign object is moved, antibiotics are generally not needed. In children, vaginal lavage or irrigation is the method of choice to remove small bits of fibrous tissue.

Removal of larger objects may be accomplished in the outpatient setting or may require sedation or evaluation in the operating room.

• Analgesia or anesthesia at the time of removal may make the procedure more comfortable.
• Teenagers and older women may generally have foreign bodies removed in the outpatient setting; however, those patients who are unable to cooperate for an exam may also benefit from sedation or removal in the operating room.
• Larger objects and those causing pain after placement in the vagina may require anesthesia for complete removal and inspection of the vaginal walls.
• These more complex procedures may require prophylactic or therapeutic antibiotics.

Larger objects and objects causing painful infections will require anesthesia for pain and relaxation of vaginal muscles. Objects that have migrated from the vagina to the abdomen, bladder, or rectum; or to other parts of the body will require surgery for removal. An exploratory procedure with the assistance of specialists in urology or bowel surgery may be needed.

Once the object is removed and antibiotic medication is given, infection, fever, pain, and vaginal discharge should soon clear up.

If symptoms of vaginal discharge, bleeding, abnormal odor or urinary tract symptoms continue after an object has been removed, a repeat evaluation by a health care professional is recommended.

If symptoms resolve once a foreign body is removed, follow-up may not be necessary.

Repeat examination may be recommended if the health care professional is not certain the entire object has been removed or if any complexity, such as secondary infection is diagnosed at the time of removal of the foreign body.

Removal of vaginal foreign bodies with secondary complications in the pelvis, bladder, or rectum may require extensive visits to assess healing and may require subsequent testing. Placement of foreign bodies by people with altered mental status may require psychiatric or substance abuse care.

Prevention of infections related to foreign objects in the vagina begins with good vulvovaginal hygiene.

• In young children, parents should instruct perineal cleaning by wiping front to back. This will decrease the number of bacteria and feces that may enter the vagina. Poor perineal hygiene may cause irritation of the vulva or vagina.
• Parents can also aid in the prevention of foreign bodies of the vagina by talking with children about their bodies and teaching them the proper names of their body parts, such as the vagina, urethra, anus, and rectum. Knowing the correct names of body parts will allow children to better communicate any problems. For example, children may be able to describe these body parts to adults in instances of pain, discharge, or possible abuse.
• For older girls and women, good hygiene includes limiting the number of times objects remain in the vagina. Tampons should be used no longer than 6-8 hours.
• Sexual activities resulting in the painful placement of objects in the vagina should be avoided.

Medications for vaginal infections or irritation should be used only when prescribed by a health care professional. Patients may commonly misdiagnose the etiology of a vaginal discharge. Douches or vaginal washes are not needed to clean the vagina. Repeated douching may increase the risk of infection due to washing away the normal bacteria which help to fight infection. Showers and baths are satisfactory for cleaning the vulva and perineum.

Once the vaginal foreign body is removed, related symptoms of infection, pain, and discharge should quickly resolve.

• If the foreign body has been in the vagina for a long period of time and has caused an infection, antibiotics may be prescribed; however, they are not customarily required.
• Serious complications rarely occur, if the infection enters the deep pelvic tissues or peritoneal cavity. Infections in the pelvis can cause secondary inflammation and scarring, resulting in pain or infertility.