Disease Description (Causes and Symptoms)
- Definition: A condition in which a foreign object enters and remains in the vulva or vagina, causing inflammation, infection, discharge, pain, or other symptoms.
- Causes: In adults, retained sanitary products such as tampons or pieces of condoms are common causes. In children, the main cause is insertion of small objects out of curiosity (depending on the circumstances, child abuse may need to be suspected).
- Pathophysiology: If a foreign object remains for more than 48 hours, the normal bacterial balance in the vagina can be disrupted, allowing overgrowth of gram-negative bacteria (E. coli) and anaerobic bacteria, which may cause localized infection and suppuration. If a penetrating wound occurs, the condition may progress to intra-abdominal problems (acute abdominal pain).
- Main symptoms: Foul-smelling abnormal vaginal discharge (purulent or bloody), localized pain, vulvar irritation and redness, abdominal pain (in severe cases), and bleeding.
Treatment Methods
- Initial treatment
- Remove the foreign object as quickly as possible (performed in an outpatient clinic or emergency room under visual examination and speculum examination). In children, removal is performed with appropriate sedation and analgesia.
- After removal, check for wounds and bleeding and test the discharge (culture and, if necessary, sexually transmitted infection testing).
- Medication treatment
- If there are signs of localized or systemic infection, antibiotic treatment is given. Selection depends on the clinical presentation and culture results; antibiotics covering gram-negative and anaerobic bacteria in the vagina may be considered (e.g., a beta-lactam/beta-lactamase inhibitor or a cephalosporin plus metronidazole). Pediatric prescriptions and dosages should follow pediatric guidelines.
- Use local antiseptics and sitz baths (as directed by a doctor) to remove discharge and maintain hygiene.
- In severe cases or when complications occur
- If extensive infection, an abscess, or tissue necrosis is suspected, hospitalization, intravenous antibiotics, and surgical drainage or other surgical treatment are necessary.
- Additional care
- Pain control, wound care, and follow-up after 1–2 weeks to confirm healing.
- In children, if there is repeated insertion, unusual behavior, or signs of trauma, an evaluation related to child abuse should be performed, with referral to social welfare services or legal reporting as necessary.
- Precautions (including self-care)
- Do not try to remove the object forcefully yourself; visit a medical facility immediately.
- When using tampons, follow the recommended replacement schedule and maintain thorough hand hygiene.
- Additional testing is recommended if there is sexual activity or a risk of sexually transmitted infections.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare
- A list of medications currently being taken (including antibiotics, anticoagulants, etc.)
- History of previous gynecological surgeries or treatments and allergies (especially to antibiotics)
- When symptoms began and how they have progressed (changes in the color, smell, and amount of discharge; location and intensity of pain; whether there is a fever)
- In children, a record of the observed circumstances (what was inserted, who was present, etc.)
- Preparing test results and other information
- Recent gynecological test results, if available, or photographs of the injury, if possible
- Example symptom records (to show the doctor)
- “When did the discharge first appear, including the date and time?”
- “What color is the discharge (yellow/green/bloody)? Does it have a foul odor?”
- “Have you recently had menstruation, sexual intercourse, tampon use, or vaginal cleansing (using a vaginal irrigator)?”
- Contraindications/precautions before an outpatient visit
- If the condition worsens after attempting self-removal, visit the emergency room immediately.
- For children, check in advance whether sedation will be necessary for the examination or treatment.
Examples of General Questions to Ask the Doctor
- “What is the purpose of the antibiotic you recommend this time, and what possible side effects does it have?”
- “Are additional tests (culture, sexually transmitted infection testing, ultrasound, etc.) needed after the foreign object is removed?”
- “How long is healing expected to take, and what lifestyle guidelines can help prevent recurrence?”
Examples of Condition-Specific Questions
- (Adult) “If I inserted a tampon and forgot about it, is it okay without antibiotics, and how long can I wait and monitor the situation?”
- (Child’s guardian) “If a foreign object is repeatedly inserted into a child, what are the criteria for determining that this constitutes child abuse, and what procedures will follow?”