8.04 Vaginal Foreign Bodies
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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:
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- 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
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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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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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