Vaginal foreign body in childhood: A multidisciplinary approach

Abstract

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.

Nonobstetric lower genital tract injuries in rural India

“…Vaginal foreign bodies in children require examination under anesthesia [7,9]. Removal demands both special expertise and instruments, along with a pediatric anesthetic service that is rarely available in low-income countries [14,22].…”

“…Furthermore, a lack of adequate blood transfusion facilities and other services in rural settings can adversely affect outcome [22]. Currently, despite concerted developmental health sector efforts, most of the first referral units in the reproductive and child health program in rural India are not well equipped to provide adequate management, especially when the extent and severity of injuries requires examination under anesthesia with a multidisciplinary approach [9,12,22].…”

“…Because of their nature, extent, and the underlying mechanism of trauma, some of these injuries are unique [2][3][4][5][6][7][8] and can pose diagnostic and management challenges to clinicians, even in well-equipped centers [1,4,[10][11][12]. Several case reports [4,[7][8][9]13] and occasional case series [1,5,10,11] from high-income countries have been published, but little information is available on the implications of lower genital tract injuries among women in low-income countries, especially among those living in rural areas [2,3]. While some reports have dealt exclusively with coital trauma [3,4,10], including sexual assault and rape [3][4][5]10], none have explored the difficulties encountered in managing a wider spectrum of injuries.…”

“…The etiological factors of nonobstetric genital tract injury (NOGTI) are associated with age, marital status, residential location, occupation, socioeconomic status, leisure and sporting activities, and sexual behavior [1][2][3][4][5][6][7][8][9]. Because of their nature, extent, and the underlying mechanism of trauma, some of these injuries are unique [2][3][4][5][6][7][8] and can pose diagnostic and management challenges to clinicians, even in well-equipped centers [1,4,[10][11][12].…”

What is your diagnosis?

“…Some authors have also reported a method performed by ultrasonography consisting of the use of three-dimensional saline infusion vaginography as an adjunctive modality in the same indications (13). Vaginography has also been described to allow the indirect visualization of an intravaginal foreign body in childhood (14). We can draw the following conclusions from this case: VF represents a condition with profound and devastating consequences for the patient.…”