Inside out

Case notes

An 84-year-old woman presented with acute urinary retention. Physical examination revealed that her vagina was protruding from her body, trapped within a ring pessary that had been inserted 5 days earlier ( Figure ). The patient reported that following placement, the device was not dislodged by standing or sitting positions or by the Valsalva maneuver. She had no difficulty with urination or defecation while wearing the pessary. Exteriorization and incarceration of the vagina had occurred after she abruptly assumed a squatting position.