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
Longwood Information LLC 4822 Quebec St NW Wash DC
1.202.237.0971 fax 1.202.244.8393
[email protected]
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