Vaginal Foreign Body Research Articles

Emergent and Surgical Interventions for Injuries Associated With Eroticism: a Review

To review the consequences of sexual activities that can cause severe morbidity and the current emergent and surgical measures for treating them. A computerized search of the English and non-English MEDLINE database (January 1973 to October 2005) identified the major sexual activities that caused injuries requiring emergent or surgical intervention, or both. These activities were grouped by type, pathologic findings, and sites of injury. Cause and symptoms are discussed, as are the radiologic, emergent and surgical interventions employed worldwide. Two major groups of sexual-erotic activities, whether self-inflicted or accidental, emerged as culpable for most of the injuries. One was hetero-homosexual relations that were associated with penile fracture and Peyronie's disease. The other was related to the sequelae of autoeroticism and included penile constriction devices, anorectal, urethra-bladder, and vaginal foreign bodies as well as autoerotic asphyxiation. Injuries in both groups affected men more than women (e.g., 1.7:1 for foreign bodies in the urethra and 99:1 for anorectal). Complications were either immediate or delayed. Predisposing factors for injury are described. Emergent medical management and corrective surgical measures (usually by urologists and gynecologists for genital involvement and proctologists and general surgeons for rectal involvement) were similar worldwide and the need for them was surprisingly limited. Most erotic activity-related injuries are medically or surgically treatable, although some sexual practices can be lethal. Dissemination of information on risk of injury is the best preventive measure.

Forgotten Vaginal Pessary Discovered after 30 years

Foreign body in vagina is common in young children such an event in adults is rare. We present a case of a long forgotten vaginal foreign body (pessary) detected 30 years after its insertion in a 78 year old lady. The patient presented with malodorous discharge pervaginum. The pessary was retrieved under sedation. The patient has been asymptomatic thereafter.

Vaginal Discharge and Bleeding in Girls Younger Than 6 Years

Persistent unexplained vaginal discharge or bleeding in the pediatric population may be the only manifestation of a serious underlying medical or social problem. Therefore, these symptoms require careful and complete evaluation to identify the primary pathology accurately. We retrospectively reviewed charts of patients who presented for evaluation of persistent vaginal discharge or bleeding to determine if noninvasive imaging was a sensitive means of screening for gynecological pathology. The records of 24 girls younger than 6 years who presented with vaginal discharge or bleeding were reviewed retrospectively. All patients were evaluated with noninvasive imaging, a pelvic examination while under anesthesia, vaginoscopy and cystoscopy. Noninvasive imaging was useful in identifying 5 of 7 vaginal foreign bodies. However, noninvasive imaging identified only 2 of 6 malignancies. These malignancies consisted of rhabdomyosarcoma (3 patients) and endodermal sinus tumor (3). Two girls also had benign vaginal mullerian papillomas that were not identified by noninvasive imaging. Noninvasive imaging did not aid in the diagnosis of sexual abuse. Based on these data, we recommend that all girls younger than 6 years who present with persistent vaginal discharge or bleeding be evaluated with pelvic examination while under anesthesia, to be followed by vaginoscopy and cystoscopy if no readily identifiable pathology is found by simple genital examination alone, regardless of the results of noninvasive imaging studies.

Vaginal foreign body in childhood: A multidisciplinary approach

A 5-year-old girl referred to our division for evaluation of persisting foul-smelling brown vaginal discharge with pruritus for over 2 years, not corresponding to antibiotic therapy. Transabdominal ultrasound identified a heterogeneous mass intensely fixed in the upper third of vaginal wall. Vaginography revealed a filling defect in the upper part of vagina, confirming the diagnosis of an intravaginal foreign body. The foreign body was grasped and removed by traction; it turned out to be a thin double-wrapped piece of sponge. Psychological assessment of the girl was undertaken, in order to illuminate the potential of an underlying emotional and behavioural problem and revealed the existence of psychological disturbances mostly affecting social competence and adaptiveness.

Vaginal foreign bodies.

To evaluate the clinical features and outcome in girls with a vaginal foreign body. Retrospective review of medical records of 35 girls with a vaginal foreign body seen in an outpatient clinic for paediatric and adolescent gynaecology between 1980 and 2000. The ages ranged from 2.6 to 9.2 years. The most common symptom was blood-stained vaginal discharge/vaginal bleeding (49%). Duration of symptoms varied from 1 day to 2 years. Fifty-four percent of the patients recalled insertion of the foreign object, usually by the girl herself. All but three patients (91%) either recalled insertion of the foreign object and/or had vaginal bleeding or blood-stained or foul-smelling vaginal discharge, and/or visualization or palpation of the foreign body in physical examination. Symptoms resolved after removal of the foreign body followed by a single irrigation with Providon-Iod (Betadine). In the majority of patients a carefully obtained history and physical examination suggest the diagnosis of a vaginal foreign object. The leading symptoms are vaginal bleeding and blood-stained or foul smelling vaginal discharge. Removal of the foreign object followed by a single irrigation with Providon-Iod is the definitive treatment and does not require additional measures.

治療に難渋したちつ内異物による直腸ちつろうの１例

症例は23歳女性.5年前にスプレー缶の蓋を膣内に留置してしまったが医療機関を受診せず放置し,次第に月経周期に類似した下血と腰痛が出現したため近医を受診した.大腸内視鏡検査で膣内異物と直腸膣瘻を指摘され経肛門的に異物除去術が施行されたが,2カ月後も瘻孔が閉鎖しないため当科を紹介された.初診時2横指大の直腸膣瘻と膣狭窄を認めた.回腸にループ式人工肛門が増設されたが6カ月後も瘻孔は閉鎖せず,根治目的に手術が施行された.瘻孔周辺の直腸と膣は高度の線維化により強固に癒着しており直腸・膣の修復は不可能であったため,再手術により子宮摘出・直腸切除,結腸肛門吻合術が施行された.3年2カ月の間にこれらの手術を含む計6回の手術が行われ直腸膣瘻は根治した.膣内異物による直腸膣瘻はまれな病態であるが,治療に難渋した自験例を若干の文献的考察を加え報告する.

Recurrent, purulent vaginal discharge associated with longstanding presence of a foreign body and vaginal stenosis

A 13-year-old presented with malodorous, purulent, vaginal discharge following each menses for the last three months since menarche. This discharge resolved following antibiotic therapy but recurred with each menses. On exam, the patient was found to have a blind ending vagina with a small, midline perforation. Ultrasound and MRI examinations done prior to surgery did not identify the vaginal foreign body. She was taken to the operating room for examination under anesthesia and vaginoscopy. During surgery this area was found to be comprised of dense adhesions which nearly obliterated the distal vagina. The vaginal adhesions were lysed and a plastic foreign body was discovered in the upper vagina. After removing the foreign body the superior vagina was undermined, pulled down, and sutured to normal inferior vagina. A Mentor mold was placed in the vagina to maintain patency.

US of the pediatric female pelvis: a clinical perspective.

When investigating pelvic pathologic conditions in female pediatric patients, one needs to be aware of the developmental changes that take place around puberty. The prepubertal uterus is thin, with a fundus equal in size to the cervix. Owing to the hormonal stimulation of puberty, the uterus enlarges and the fundus becomes prominent. The ovaries are demonstrated with ultrasonography (US) at all ages. Ovarian volume increases after 6 years of age. Microcystic follicles are normally seen throughout childhood. US is the modality of choice for imaging the pediatric female pelvis. The main indications for pelvic US in the pediatric age group are pubertal precocity or pubertal delay, pelvic pain or pelvic masses, and ambiguous genitalia. Vaginal bleeding in the prepubertal child can be due to a vaginal foreign body, vaginal rhabdomyosarcoma, or precocious puberty. Common causes of primary amenorrhea in teenagers include gonadal dysgenesis (Turner syndrome) and müllerian (uterovaginal) anomalies. Pelvic pain or pelvic masses in pediatric patients can be due to ovarian torsion, hemorrhagic ovarian cyst, pelvic inflammatory disease, or ectopic pregnancy.

Operative Entfernung eines inkarzerierten vaginalen Fremdkörpers (Plastikbecher) nach jahrelanger Mißhandlung

A 23-year old patient, gravida-0, was admitted for surgical removal of a vaginal foreign body. She complained of yellow vaginal discharge and persistent pelvic pain over the last three months. History revealed that 4 years ago the patient had been regularly sexually abused by her partner over a period of 21/2 years. She denied any sexual activity with her actual partner. Pelvic examination revealed a hard, rimmed foreign body in the left parametran space between urinary bladder and rectum. After cystoscopy and rectoscopy we tried to remove the foreign body from the vagina with laparoscopic assistance. Pfannenstiel-laparotomy had to be performed and the object was grasped with Kocher clamps. The foreign body was removed vaginally out of a paravaginal cavity between urinary bladder and rectum on the left side by applying traction on the clamps after intraoperative, intraabdominal ultrasound. The foreign body was identified as a 40 x 32 mm rimmed plastic cup. We discuss the importance of presurgical history, pelvic examination, intraoperative ultrasound orientation and exact planning of the surgical procedure with detailed information from the patient. Psychotherapeutical aspects are considered.

Diagnostic difficulties from a vaginal foreign body with a 6-year duration.

A 22-year-old nulligravida was evaluated at a hospital for persistent vaginal bleeding and malodorous discharge. She was considered to have a foreign body in her vagina, apparently penetrating the uterine cervix with perforation into the peritoneal cavity. By history the object had been present for 6 years. She was transferred to our university hospital for surgical removal. On computed tomography and magnetic resonance imaging, the object was cylindrical and was located in the vaginal vault without evidence of perforation. With both modalities it appeared lucent relative to surrounding tissues. Removal required limited dissection of the vaginal wall, and the object proved to be a plastic container cap. No vesico-vaginal fistula or other complication was present. Precise early diagnosis was difficult in this case, but details of the chief complaint offered valuable clues and imaging was informative.

Vaginal Bleeding in Pediatric Patients

<h3>Background</h3> The purpose of this study <i>is</i> to evaluate the underlying cause of vaginal bleeding in all pediatric patients and to specifically evaluate the underlying cause of menorrhagia. <h3>Methods</h3> This retrospective chart review examined 134 patients with the coded diagnosis of vaginal bleeding seen at a tertiary children's medical center either emergency or outpatient setting from January, 1993 to April, 1996. <h3>Results</h3> One hundred thirty-four charts were reviewed with 79 (59.0%) seen initially in emergency department and 55 (41.0%) seen in an outpatient setting. There were 3 admissions (2.2%). The age range was 4 days to 20 years: <28 days=13 (9.7%); 29 days to 2 years=10 (7.5%); 2 years to 9 years=14 (10.4%); and > 9 years=97 (72.4%). The most common diagnoses were breakthrough bleeding with a birth control method (31 or 23.1%), dysfunctional uterine bleeding (24 or 17.9%), abnormal uterine bleeding (20 or 14.9%), neonatal withdrawal (12 or 9.0%), trauma including sexual abuse (9 or 6.7%), spontaneous abortion (8 or 6.0%), vulvovaginitis (8 or 6.0%), and miscel1aneous other diagnosis (menses, vaginal polyp, vaginal yolk sac tumor, foreign body, and central precocious puberty). The common causes of vaginal bleeding were age-related. In the neonates, 92.3% (12/13) of vaginal bleeding was due to neonatal estrogen withdrawal. In the 2 to 9 year old children, 42.9% (6/14) of vaginal bleeding was caused by trauma with half due to sexual abuse; 42.9% (6/14) was due to vulvovaginitis. In the adolescents (>9 years old), 32.0% (31/97) of vaginal bleeding was due to birth control method including depo provera, Norplant and oral contraceptives in order of frequency. The coded diagnoses of dysfunctional uterine bleeding and abnormal uterine bleeding accounted for 25.8% (25/97) and 16.5% (16/97) of adolescent vaginal bleeding, respectively. Eight percent (8/97) of adolescents had spontaneous abortions. For the purpose of analysis, menorrhagia was defined as heavy vaginal bleeding (>1 pad per hour) or prolonged bleeding (>7 days) with clinical evidence of bleeding such as blood on pelvic exam or anemia (hemoglobin< 11.5g/dl or hematocrit <35.0%). All 21 patients (15.7% of all patients) with menorrhagia were between the ages of 10 to 20 years accounting for 21.6% (21/97) of adolescent vaginal bleeding. Menorrhagi was due to dysfunctional uterine bleeding in 57.1% (12/21) and a coagulopathy in 19% (4/21). The most common coagulopathy was von Willebrand's disease, found in 2 cases, followed by liver disease in 1 case and thrombocytopenia from aplastic anemia in 1 case. One case of menorrhagia was due to bleeding from Norplant, and 1 case was due to bleeding after a LEEP procedure to the cervix. <h3>Conclusions</h3> The most common causes of vaginal bleeding in pediatric patients are age-related. In children and neonates, neonatal withdrawal, vulvovaginitis and trauma including sexual abuse are most common. In adolescents, bleeding from a birth control method and dysfunctional uterine bleeding are most common. Menorrhagia was seen in 21% of our adolescents, and this study reflects prior data with 19% of adolescents with menorrhagia having an underlying coagulopathy.

Urinary Tract Infection With a Neglected Vaginal Foreign Body

Urinary Tract Infection With a Neglected Vaginal Foreign Body

Urinary Tract Infection With a Neglected Vaginal Foreign Body

Urinary Tract Infection With a Neglected Vaginal Foreign Body

A Case of Vaginal Foreign Body in a 5 Year-Old Female

A Case of Vaginal Foreign Body in a 5 Year-Old Female

Atypical presentation of a vaginal foreign body

Atypical presentation of a vaginal foreign body

Hysteroscopic extraction of a vaginal foreign body in a child

A 3.5-year-old girl had a persistent, foul-smelling, blood-tinged vaginal discharge. She was initially treated for recurrent and persistent vulvovaginitis, which resulted in no improvement. Vaginoscopy revealed an intravaginal foreign body, which was removed successfully by hysteroscopy. We believe hysteroscopy is safe, convenient, effective, and easy to perform, even in a child.

The role of sonography in the detection of vaginal foreign bodies in young girls: the bladder indentation sign

The cases of four young girls with vaginal foreign bodies, successfully diagnosed by ultrasound, are presented. The sonographic signs include varying echogenicity and acoustic shadowing, but always an indentation of the posterior bladder wall was clearly observed. Sonography should be considered as the first step in the evaluation of suspected vaginal foreign bodies in young girls.

First report of a vaginal foreign body perforating into the retroperitoneum

Pelvic examination of a 19-year-old woman with recurrent pain after multiple laparotomies revealed a 4.0 cm paracervical fibroepithelial polyp and tender fullness in the left pelvis. Abdominal exploration had normal findings, but exploration of the retroperitoneum revealed an encysted bottle cap that had eroded through the vaginal wall years before.

Vaginal foreign bodies in women in postmenopause and in senium

We report on three women, 81, 73 and 69 years of age, in whom foreign bodies had been introduced into the vagina either by the patients themselves or by somebody else. In all cases, medical help was needed to remove the object. In one patient the foreign body had remained within the vagina for 7 years. Only two of the three women admitted that the object had been introduced for sexual stimulation. Some papers are quoted that report on similar events, however, in younger patients. Our observations demonstrate the often problematical sexual situation of many old people.

Vaginal foreign bodies and child sexual abuse: Herman-Giddens ME. Arch Pediatr Adolesc Med. 1994;148:195–200

Vaginal foreign bodies and child sexual abuse: Herman-Giddens ME. Arch Pediatr Adolesc Med. 1994;148:195–200