Foreign Body in the Vagina of A four-Year-Old-Girl: A Childish Prank or Sexual Abuse

Sakhavar, Nahid; Teimoori, Batool; Ghasemi, Marzie

doi:10.5812/ijhrba.10534

Cited by 7 publications

(7 citation statements)

References 6 publications

(7 reference statements)

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“…In review of the published literature, there was a significant variation in the approach to the evaluation of a pediatric VFB. Sexual abuse was mentioned as part of the differential diagnosis or discussion most frequently for these girls when the chief complaint involved reports of vaginal discharge, or less commonly, abdominal pain 25–30,32,34,36–41,43–52,55,57,58,63 . Sexual abuse was a later consideration in the diagnoses of anorectal foreign bodies for the 3 younger male patients described.…”

Section: Discussionmentioning

confidence: 99%

“…Sexual abuse was mentioned as part of the differential diagnosis or discussion most frequently for these girls when the chief complaint involved reports of vaginal discharge, or less commonly, abdominal pain. [25][26][27][28][29][30]32,34,[36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52]55,57,58,63 Sexual abuse was a later consideration in the diagnoses of anorectal foreign bodies for the 3 younger male patients described. For these boys, the history of present illness was revisited upon detecting the foreign objects in the workup for their chief complaints of abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

“…The younger children with vaginal injury were referred to psychiatry for evaluation with occasional consideration of CSA. [43][44][45] The 10-year-old sister who had perpetrated the introduction of foreign bodies into her 6-year-old sister also received a psychiatry referral. 43 There was no safety or mental health action taken for the premenarchal, preandrenarchal 14-year-old with unexplained vaginal injury.…”

Section: Literature Reviewmentioning

confidence: 99%

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Polyembolokoilamania in Child Sexual Abuse

2022

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Objective: To characterize the physical examination findings in children and adolescents who disclosed insertion of an object into their bodies as part of their sexual abuse history and to identify how this population compares to similar cases described in the published literature.Methods: This is a 15-year retrospective review of children younger than 18 years seen at a large urban children's assessment center. In addition, we reviewed and summarized the last two decades of literature characterizing pediatric anogenital foreign bodies to better understand previously described findings in similar populations.Results: Sixty-eight children whose abuse histories included anal or genital insertion of a foreign body still presented with normal examination findings in the vast majority (89.7%) of cases, despite the diversity of items described. The literature on anogenital foreign bodies was sparse, offered a variety of approaches to the overall evaluation of such cases, and demonstrated inconsistent consideration of child sexual abuse in response to the diagnosis.Conclusions: This article further supports the literature reflecting the overall rarity of abnormal anogenital findings in the clinical assessment for sexual abuse.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Polyembolokoilamania in Child Sexual Abuse

2022

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“…The etiologies of vaginal bleeding that must be considered include foreign bodies, precocious puberty, exogenous hormone intake, infection, sexually transmitted diseases, autoimmune conditions, poor hygiene, irritants, sexual abuse, urinary tract infection, urethral prolapse, and neoplasm. [1][2][3][4][5] We present a unique case of a 6-year-old girl who was first suspected of suffering from precocious puberty, lost to follow-up for 1 year, and then eventually diagnosed with multiple vaginal foreign bodies. Vaginoscopy under general anesthesia was needed to determine the cause of vaginal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Persistent Vaginal Bleeding in a Six-Year-Old

Garcia

Glikes

Nield

et al. 2015

Clin Pediatr (Phila)

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A 6-year-old girl presents with a 1-year history of vaginal bleeding. The child had been evaluated 1 year prior for the same complaint by pediatric endocrinology. Physical examination was unremarkable at that time except for a body mass index (BMI) of 23.47 (above 95th percentile). Pubic and breast development were at Tanner Stage 1, and laboratory findings were essentially within normal limits including glucose 105 mg/dL (74-106), creatinine 0.4 mg/dL, potassium 4.4 mmol/L (3.5-5.1), CO 2 22 mmol/L (22-30), free T4 0.87 ng/dL (0.78-2.19), androstenedione <15.0 ng/dL (30-240), 17-OH progesterone <40 ng/dL (<100), and estradiol <19 pg/mL (<20). Minimally elevated laboratory findings included sodium 146 mmol/L (137-145), thyroid-stimulating hormone 4.85 µIU/mL (0.47-4.68), and dehydroepiandrosterone 1.7 ng/ml (0.3-1.3). Bone age for her chronological age of 5 and 9/12 years was advanced at approximately 7 and 10/12 years to 8 and 10/12 years. Transabdominal pelvic ultrasound revealed no structural abnormalities with normal female anatomy. The patient was lost to follow-up due to removal from mother's custody by Child Protective Services (CPS) for suspected sexual abuse. While in CPS custody, the girl displayed hypersexual and masturbatory behavior. During this timeframe, the patient required the use of a panty liner to manage vaginal bleeding, prompting CPS to resume evaluation of the origin of her vaginal bleeding, and the child was referred to gynecology. The current physical examination was unremarkable and revealed a BMI of 22.11 (above 95th percentile). Breast and pubic development continued at Tanner Stage 1. Hospital CourseIn order to elucidate the cause of vaginal bleeding, vaginoscopy under general anesthesia was performed in the operating room with the patient in frog leg position. Vaginal examination revealed erythematous labia majora, without tears or abnormalities of the hymen. Foulsmelling vaginal odor was present. Vaginal swabs were sent for gonorrhea and chlamydia cultures. On insertion of the pediatric cystoscope, an unknown foreign object was visualized within the vaginal canal. Removal of the object revealed significant erosion into the lateral walls of the vaginal canal, as well 3 additional plastic objects of undetermined origin (Figure 1). The vaginal tissue of the sidewalls and vaginal fornices had become hypertrophic and partially embedded the foreign bodies, indicating that they had been there for an extended period of time. Due to possible erosion into the abdominal cavity by the foreign bodies, the vagina was filled with Gastrograffin and plain film abdominal x-rays were obtained in the operating room, confirming the absence of abdominal penetration.The patient is currently in custody of the state as child abuse allegations are being investigated. Consultation with pediatric endocrinology is also scheduled as follow-up for the elevated BMI, bone age, and laboratory studies. The vaginal bleeding has ceased. Final DiagnosisVaginal bleeding due to erosion of vaginal wall due to foreign bodie...

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“…In case of negative findings vaginal irrigation and/or diagnostic vaginoscopy should be considered [1]. The foreign body can be removed easily like in our case, or by the use of a narrow illuminated endoscope [2]. Even though rare, the possibility of foreign body in the vagina should be kept in mind while examining any child with vulvovaginal symptoms.…”

Section: Letter To Editormentioning

confidence: 99%

Vaginal Discharge in Prepuberal Girls

Elghanmi¹

2016

OGIJ

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Foreign Body in the Vagina of A four-Year-Old-Girl: A Childish Prank or Sexual Abuse

Cited by 7 publications

References 6 publications

Polyembolokoilamania in Child Sexual Abuse

Polyembolokoilamania in Child Sexual Abuse

Persistent Vaginal Bleeding in a Six-Year-Old

Vaginal Discharge in Prepuberal Girls

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