Diagnosis and Management of Vaginal Foreign Body in the Pediatric Patient Using Vaginoscopy: A Case Report

Abstract

Study Objective To present a pediatric case with nonspecific vaginal symptoms where exam under anesthesia and vaginoscopy were indicated as a diagnostic and therapeutic measure. To review the strengths of vaginoscopy in this specific population. To describe vaginoscopy instrumentation and techniques given the infrequent use of this modality in gynecologic practice. Design Case Report. Setting Academic Hospital. Patients or Participants A 5-year-old pre-pubertal female presented with persistent vaginal discharge and spotting for four months. Prior workup and treatment included empiric antibiotics given for urinary tract infection and wet prep and vaginal cultures that were unrevealing. Interventions Vaginoscopy was performed in the operating room under general anesthesia using a 6mm 0-degree operative hysteroscope and distension of the vaginal cavity using saline media. Measurements and Main Results Visualization of the vaginal cavity demonstrated multiple foreign bodies including nine 1-cm rubber-bands, one 3-cm LEGO toy, and multiple fragments of toilet paper. The foreign bodies were removed using flexible graspers without complications. Visualization of the vaginal cavity and cervix thereafter ensured complete removal of all foreign objects (photos available). Care was taken to document examination of the external genitalia and hymen preceding vaginoscopy in the event that further investigation for sexual abuse was warranted. Conclusion Vaginoscopy is a minimally invasive tool critical in the diagnosis and management of pediatric vaginal symptoms including evaluation for presence of foreign bodies. A multitude of hystero- or cystoscopes can be used for evaluation of vagina, however an operative channel is required in case there is a need for a biopsy or removal of a foreign body. Zero-degree optics are preferable. Benefits include preservation of hymenal integrity, enhanced visualization of the vaginal cavity, and increased flexibility in obtaining samples and removing foreign bodies.