Vaginal foreign bodies in the prepubertal child frequently lead to vaginitis, vulvovaginitis, nonspecific genitourinary symptoms, and friability of the vaginal tissues with or without frank vaginal bleeding (1,2,3). Patients with vaginal foreign bodies commonly are symptomatic and present with either bright red vaginal bleeding or purulent, foul-smelling, sometimes bloody vaginal discharge (4,5). Asymptomatic foreign bodies have also been described. Once diagnosed, the object must be removed from the vagina to avoid a progression of genitourinary symptoms and superinfection of the vaginal area. Serious complications may occur as sequelae of long-standing vaginal foreign bodies, including traumatic lesions to the vagina, bladder, rectum, and urethra as well as fistula formation (6,7,8).

Early reports described a “veritable museum of curiosities” removed from the vagina, including batteries, beads, bits of toys, folded paper, cherries, cotton, corks, crayons, hairpins, insects, marbles, marker tips, nuts, paper clips, pencil erasers, pins, plum pits, safety pins, sand, shells, splinters of wood, stones, tampons, toilet tissue, and twigs (1,2,4,9,10). The most common material recovered is toilet tissue, which may be fecally contaminated (2,5,9). Owing to natural curiosity, body exploration, and hygienic habits, toddlers and school-age girls are the most likely to present with vaginal foreign bodies.

In the prepubertal child, irrigation of the vagina with normal saline or sterile water may be sufficient to dislodge the foreign body. If unsuccessful, removal under general anesthesia may be required. For use in the adult patient, forceps, vacuum suction, and other gynecologic and/or obstetrical instruments have been advocated (6,10,11,12). These are unlikely to be tolerated in the prepubertal child and are generally not appropriate for this age group. Occasionally, a moistened cotton swab can be used to retrieve toilet tissue visible in the vaginal vault. Examination for a foreign body should be done in accordance with the techniques described in Chapter 91. The knee-chest position allows for good visualization into the vaginal vault and may be helpful for cases of a possible foreign body. If a foreign body is suspected, saline irrigation should be performed by the examining physician or nurse practitioner. This procedure can be easily accomplished with equipment generally available in the ambulatory setting, including clinics, emergency departments, and primary care offices. It is a simple procedure whose success depends primarily on the cooperation of the child and the patience of the provider.