Corpus Alienum Vaginae

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A 6-year old girl presented with dysuria and itching in the perineum and was found to have a vaginal foreign body which was a broken safety pin. Radiographs revealed another piece was left in the vagina which was later removed under anesthesia.

A broken safety pin.

Vaginoscopy was performed and the broken pin was removed from the posterior vaginal fornix with long artery forceps.

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120]

Case Report

Vaginal Foreign Body in a Child: Sexual Abuse or Sibling Prank?


Rahul Gupta, Badri Lal Patidar1

Departments of Paediatric Vaginal foreign body is a rare condition. We present a 6-year-old girl who had

Abstract
Surgery and 1Obstetrics and
Gynaecology, Kota Medical
dysuria and itching in the perineum; examination revealed a vaginal foreign body
College, Kota, Rajasthan, which was a broken safety pin. Radiographs after its removal revealed a pin of
India the safety pin left in the vagina which was later removed under anesthesia. A high
index of suspicion for a vaginal foreign body should be present while evaluating
a child with genitourinary complaints. Vaginal foreign body in children may be an
indicator of possible sexual abuse; although in the present case, it was a prank by
her elder sibling. Importance of postprocedural radiographs has been emphasized
after removal as multiple/broken pieces may be present, which may not have been
visualized initially. Evaluation for concurrent sexually transmitted diseases is
paramount if sexual abuse is suspected.
Received: 11-03-2018
Accepted: 05-07-2018 Keywords: Child, prank, safety pin, sexual abuse, vaginal foreign body

Introduction safety pin [Figure 1]. Vagina was carefully inspected for
the presence of other foreign bodies. After the procedure,
V aginal foreign body is a rare entity, particularly
in the pediatric population.[1,2] Vaginal foreign
body is more common in mentally retarded and young
abdominopelvic radiographs (both anteroposterior
and lateral) were performed to evaluate for any other
children.[1,2] The patient may present with vaginal associated foreign bodies. It revealed radiopaque foreign
discharge or genitourinary symptoms, and the condition body in the vagina [Figure 2]. The patient was planned
may remain undiagnosed for years.[3,4] We present a for examination under anesthesia. After preparation,
6-year-old girl who presented with complaints of dysuria vaginoscopy was performed which revealed a broken
and itching in the perineum and on examination was pin near the posterior vaginal fornix. A broken pin of the
found to have a vaginal foreign body. Furthermore, a safety pin [Figure 2] was removed from the vagina with
brief review of pertinent literature is endeavored. the help of long artery forceps. Vaginal swabs were taken
for culture sensitivity. Symptoms resolved after removal
Case Report of the foreign body followed by single irrigation with
povidone-iodine. Oral antibiotics were given for 7 days to
A 6-year-old girl who lived with her parents presented
prevent infection owing to lack of the protective effects
with complaints of dysuria and itching in the perineum
of estrogen on vaginal mucosa. The vaginal swab culture
for few days. There was no history of lower abdominal
reports were normal; the patient was also evaluated for
pain or fever. There was the absence of any preceding
any sexually transmitted infections such as syphilis,
sexual abuse or family discord.
hepatitis, and HIV.
Examination revealed an anxious child with poor
On enquiring confidentially, the child revealed that while
understanding. On perineal examination and on separating
playing, her elder sister had introduced the safety pin in
her labia, no vaginal discharge was present. There
her vagina. An enquiry of the family members indulging
was the absence of any excoriation on the vaginal wall
(no obvious sign of sexual abuse), but hymen was not
Address for correspondence: Dr. Rahul Gupta,
intact. A suspicious object (a foreign body) in the lower Department of Paediatric Surgery, Kota Medical College,
vagina was seen. The foreign body was grasped with Kota, Rajasthan, India.
curved artery forceps and gently removed; it was a broken E-mail: [email protected]

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DOI:
10.4103/mjdrdypu.mjdrdypu_46_18 How to cite this article: Gupta R, Patidar BL. Vaginal foreign body in a child:
Sexual abuse or sibling prank?. Med J DY Patil Vidyapeeth 2019;12:157-9.

© 2019 Medical Journal of Dr. D.Y. Patil Vidyapeeth | Published by Wolters Kluwer - Medknow 157
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Gupta and Patidar: Vaginal foreign body in a child

a c
a b Figure 2: Abdominopelvic radiographs (a), anteroposterior and (b) lateral
showing radiopaque foreign body in the vagina, and photograph showing
Figure 1: Photograph (a) after separating the labia showing a foreign (c) broken pin of the safety pin (specimen)
body in the lower vagina; (b) removed broken safety pin

A carefully obtained history may sometimes suggest


in unnatural sexual behavior was also conducted.
the diagnosis, but a detailed examination of the
Consultation of gynecologist was sought in view of
perineum is important in an young child with urinary
hymen not being intact; any sexual offence looked
or vulvovaginal symptoms as the child may not give
unlikely. A psychiatrist opinion was also sought for the
the relevant information.[4]
patient and her 10-year-old elder sister who had inserted
the foreign body. In children, vaginal foreign body sometimes may
be incidentally diagnosed on a plain radiograph,
Discussion ultrasound, or other investigations done for some
Vaginal foreign body may result from ignorance, other reason. Transperineal ultrasonography along
accident, malice, attempts at sexual stimulation, mental with transabdominal ultrasonography has been shown
retardation, or psychotic tendencies.[2] A variety of to be very helpful in diagnosing vaginal foreign
foreign bodies may be retrieved from the vagina such bodies, especially when the size is larger than 5 mm.
as buttons, grains, hairpins, pencils, small jam jars, toys, Vaginal foreign body is hyperechoic as compared to
sweets, pieces of toilet paper, and safety pins (as seen in adjacent tissues and often with characteristic echo
the index case).[1-4] Multiple foreign bodies may also be patterns. It has been recommended for the initial
present.[2,5] evaluation of suspected vaginal foreign body cases.
It has sensitivity and specificity of 81% and 53%,
A mean age of 6.3 years was seen in a large series
respectively.[8] Pelvic radiographs (both anteroposterior
with vaginal foreign bodies in prepubertal girls.[5] The
and lateral) detect metallic and radiopaque foreign
age usually ranges from 2 to 10 years in pediatric
bodies. Pelvic radiography is less sensitive (24%)
patients.[4] The presentation is usually with recurrent,
but highly specific (91%) for vaginal foreign body.[8]
bloodstained, and foul-smelling discharge that may
Magnetic resonance imaging is the best investigative
be associated with vulvar and vaginal inflammation
modality for evaluating vaginal foreign bodies, but
up to 50% of the patients.[3,4] Spotting, vaginal
normal report does not rule out its possibility.[3,9] It is
bleeding, or bloody discharge in a prepubescent girl
radiation free in contrast to computerized tomography.
are the most observable symptom. The child may be
Finally, direct visualization of vagina under anesthesia is
symptomatic for years and purulent discharge may
confirmatory.[3]
be resistant to antibiotic therapy.[4] Symptoms may
include lower abdomen pain or in the suprapubic Once diagnosed, the removal of foreign body is the
region, frequency, burning sensation, or dysuria (as definitive treatment. In the first attempt, we could do it
seen in our case).[6,7] Complications such as vaginal as the outpatient procedure, because the girl was very
perforation, fistulae formation, and systemic infection cooperative and the foreign body was in the lower
have also been reported.[6] Ascending infection may portion of vagina. The removal of a vaginal foreign
lead to salpingitis, pelvic inflammatory disease, and body in outdoor clinic is difficult. The procedure almost
peritonitis.[6] A high index of suspicion is required in always requires anesthesia, as was done for the remaining
diagnosing small-sized foreign body in young children. foreign body in our case.[3]

158 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 12 ¦ Issue 2 ¦ March-April 2019
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Gupta and Patidar: Vaginal foreign body in a child

A foreign body in the lower portion of vagina or near Declaration of patient consent
the introitus may be visible only by gently separating The authors certify that they have obtained all appropriate
the labia and may be removed easily with the help of an patient consent forms. In the form, the patient has given
artery forceps. However, proximally situated, pointed, her consent for her images and other clinical information
sharp, or embedded foreign body, particularly in the to be reported in the journal. The patient understands that
posterior fornix of the vagina may need an examination names and initials will not be published and due efforts
under anesthesia. Vaginoscopy or endoscopic removal will be made to conceal identity, but anonymity cannot
(as done in the index case) is the best method for removal be guaranteed.
of foreign body vagina.[3] Financial support and sponsorship
Furthermore, nonpointed, hard foreign bodies, for Nil.
example, button battery embedded in the posterior fornix
Conflicts of interest
of vagina can be felt by the examining finger inserted into
There are no conflicts of interest.
the rectum, and then, by gently maneuvering the finger in
its assisted removal (Personal experience, Rahul Gupta). References
Importance of postprocedural radiographs has also been
1. Halder P, Mandal KC, Mishra L, Debnath B. Spectrum of
emphasized after removing the vaginal foreign body vaginal foreign body in children: A report of two cases. Indian J
(as outpatient procedure) because multiple/broken pieces Paediatr Dermatol 2017;18:220-2.
may be present, which may not have been visualized 2. Padmavathy L, Ethirajan N, Rao LL. Foreign body in the vagina
initially. of a 3(1/2)‑year‑old child: Sexual abuse or a childish prank?
Indian J Dermatol Venereol Leprol 2004;70:118-9.
The foreign body may be self-inserted by the girl or 3. Chaurasia A, Gupta V, Mishra A. Vaginal foreign body in
other children while playing.[3,4] A psychiatrist opinion a 6 year old girl: A game for the child but a challenge for
the gynaecologist. Int J Reprod Contracept Obstet Gynecol
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it was prank by her elder sibling who had introduced J Paediatr Child Health 2004;40:205-7.
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sexual abuse is paramount as two-third of these girls abuse. Arch Pediatr Adolesc Med 1994;148:195-200.
with vaginal foreign body may be sexually abused.[5] 6. Chinawa J, Obu H, Uwaezuoke S. Foreign body in vagina: An
uncommon cause of vaginitis in children. Ann Med Health Sci
Consultation with child sexual abuse experts has been Res 2013;3:102-4.
recommended by experts.[10] Evaluation for concurrent 7. Dahiya P, Sangwan K, Khosla A, Seth N. Foreign body in
sexually transmitted diseases should also be done for vagina – An uncommon cause of vaginitis in children. Indian J
those with sexual abuse as one-fourth of these cases Pediatr 1999;66:466-7.
may be positive.[5] 8. Yang X, Sun L, Ye J, Li X, Tao R. Ultrasonography in detection
of vaginal foreign bodies in girls: A retrospective study. J Pediatr
Adolesc Gynecol 2017;30:620-5.
Conclusion 9. Kihara M, Sato N, Kimura H, Kamiyama M, Sekiya S,
The possibility of vaginal foreign body should be kept Takano H, et al. Magnetic resonance imaging in the evaluation
in mind while evaluating a child with genitourinary of vaginal foreign bodies in a young girl. Arch Gynecol Obstet
2001;265:221-2.
complaints such as dysuria and itching (as seen in the 10. Closson FT, Lichenstein R. Vaginal foreign bodies and child
present case) or with bloody vaginal discharge. Thorough sexual abuse: An important consideration. West J Emerg Med
perineal examination, especially in children is paramount. 2013;14:437-9.

Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 12 ¦ Issue 2 ¦ March-April 2019 159

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