Vaginal Foreign Body Evaluation and Treatment – StatPearls

Continuing Education Activity

Vaginal foreign bodies present in female patients of all ages and a wide range of healthcare settings, including the emergency department, primary care office, gynecology office, and urology office. This activity is designed to inform the reader about vaginal foreign body treatment, removal, and management. It discusses both typical and atypical presentations, as well as complications. It also provides information on how to manage removal as well as how to image patients of various ages.

Objectives:

• Identify the anatomical structures of the vagina when evaluating for foreign bodies.

• Describe the equipment, personnel, preparation, and technique in regards to removing vaginal foreign bodies.

• Review the potential complications of vaginal foreign bodies.

• Explain interprofessional team strategies for improving care and treatment for vaginal foreign bodies and improve outcomes. Strategies will be reviewed to enhance communication with patients as well as removal strategies.

Access free multiple choice questions on this topic.

Introduction

Vaginal foreign bodies present in female patients of all ages and a wide range of healthcare settings, including the emergency department, primary care office, gynecology office, and urology office. The objects found differ among age groups. Toys, tissue paper, and household objects are the most common in pediatrics. In adult women, considerations include tampons, condoms, menstrual cups, and items used for sexual gratification. Elderly patients are at increased risk for retained medical devices such as pessaries.[1][2] Patient populations such as prisoners and drug traffickers may use the vaginal canal and uterus to hide illicit substances.[3][4] In postpartum patients with recurrent abdominal pain, pelvic abscess, bladder stones, irritable bladder, and retained surgical gauze merit consideration; however, this is an unusual complication due to patient safety initiatives involving the careful counting of surgical gauze and sponges during delivery. [5]

Patients may self-report a foreign body or may present with an array of symptoms, including pelvic pain, vaginal discharge, and vaginal bleeding. There is a broad differential diagnosis for these symptoms, including malignancy, sexually transmitted infections, candidal infections, and pregnancy. The most common presenting symptom in pediatric patients is vaginal bleeding or discharge.[6]

When evaluating a patient who suspects a vaginal foreign body, history should focus on the details surrounding the initial event; this includes timing, the suspected object, and symptoms of the abdomen, pelvis, and genitalia. History taking is imperative in all patient populations. Even in pediatric patients, the majority, 54% in one study, recall the event.[6] It is essential to consider sexual abuse as a cause for foreign bodies, especially in the pediatric population.

Anatomy and Physiology

The vagina is part of the female genitalia between the urethral meatus and anus. It is a muscular canal that serves as a connection between the external genitalia and the uterus. The vaginal opening has protection from the vulva, a structure comprised of the labia majora and labia minora. At the most proximal portion of the vagina is the cervix, a highly vascularized structure that guards the entrance to the uterus.

Indications

Evaluation for foreign bodies in the vaginal canal is necessary when patients present with a self-reported foreign body or complain of pelvic pain, vaginal bleeding, or discharge. It should also be a consideration in patients with urinary and rectal complaints. In pre-pubertal patients with vaginal bleeding or persistent vaginal discharge despite antimicrobial treatment, imaging, and a gynecology referral for examination under anesthesia should be considered by primary care and emergency physicians.[7]

The examination includes a genital exam, which may include a pelvic exam with a speculum. Imaging is an option if the diagnosis is unclear or complications are suspected; this includes X-ray, CT scan, MRI, and ultrasound. The choice of imaging will vary based on presenting symptoms and patient age. Transabdominal ultrasound is the preferred modality in pediatric patients due to the lack of radiation, increased availability, and decreased level of invasiveness when compared to a transvaginal ultrasound. It has an overall sensitivity of 81% and specificity of 53%, which improves when the foreign body is over 5 mm in size. This percentage is significantly better than X-ray, which may only detect 23% of foreign bodies.[1] CT imaging is an option if complications such as fistula or abscess are suspected. 

Contraindications

It is imperative to obtain consent before performing a pelvic examination. Examinations should not take place against patient wishes, as this can constitute assault. In pediatric patients or mentally handicapped patients, consent is necessary from their legal guardians. In these patients, an obstetrics and gynecology consult can be considered to perform an exam under sedation if there is a concern for patient distress. The majority of pediatric patients are manageable with same-day surgery.[8]

The clinician should not perform a pelvic exam if there is suspicion of rape or assault if the patient or guardian has any desire to press charges. In this case, defer the pelvic exam to a specialized investigation team, as introducing anything into the vulva or vagina, even sterile lubrication, can interfere with specimen collection. This approach is a critical consideration in the pediatric population if there is any suspicion for physical or sexual abuse.

Equipment

Several modalities are useful for assessment of the presence of a foreign body in the vagina, including a pelvic exam with or without anesthesia, ultrasonography, pelvic radiography, MRI, and vaginoscopy.[1] Many foreign bodies can be removed with forceps under direct visualization, though those in place for an extended period may require surgical intervention by a gynecologist.

Persistent discharge despite antimicrobial treatment should raise suspicion of a foreign body, and evaluation should take place. [7] It should also remain in the differential for pre-pubertal patients with vaginal bleeding despite a negative ultrasound. Additional radiographic imaging, ultrasonographic imaging, or examination under anesthesia may be required to rule out a foreign body.[9]

Extreme cases may require surgical intervention to remove foreign objects due to size, position, location, and other complicating factors. General anesthesia may be used to allow for full muscle relaxation and aid in foreign body removal.

Personnel

Genital evaluation should be performed with a member of the health care team at the bedside to act as a chaperone. This may occur in an outpatient office or in the Emergency Department. It is important to ask the patient if she prefers to have a female chaperone and to consider having at least one female staff member in the room during the examination. This health care team member, if qualified, can also act as an assistant during the pelvic exam by handing equipment to the provider performing the exam.  

In pediatric patients, sedation in the operating room may be considered. In these cases, the usual operating staff, including an anesthesiologist and gynecologist, are necessary. 

If ultrasonography is used to evaluate for a foreign body, an ultrasound technician may be required to perform a transabdominal or transvaginal ultrasound.

Preparation

For routine examination in adult patients, preparation for pelvic exams includes asking the patient to remove her lower garments and providing a gown and drape. Privacy is necessary during this step, and a chaperone during the exam is paramount. It is vital that the patient feels comfortable and non-threatened. A non-sterile, lubricated speculum is usable in non-pregnant patients, and a reliable light source should be used to enhance visibility. Culture swabs should be readily available at the bedside if vaginal discharge is reported or appreciated on an exam as foreign bodies are a nidus for infection. Forceps can be brought to the bedside to aid in the removal of foreign material.  

Complications

Retained vaginal foreign bodies pose risks. Indwelling foreign objects are niduses for infection; pelvic inflammation can result in infertility.[10] Additionally, compression on surrounding tissues can compromise blood flow resulting in necrosis, a complication that can pose its own sequela, including perforation and fistulas.[10][11] Rectovaginal and vesicovaginal fistulas often occur after foreign bodies have been in place for years. These include medically placed devices such as pessaries and fractured ring IUDs in addition to materials placed by patients. These patients may present with atypical symptoms, including frequent urinary tract infections, vesicle stones, vaginal bleeding, and rectal discharge or bleeding.[12][13][14][15]

Ulceration can also occur, especially if caustic objects are present in the vaginal vault, such as batteries.[10] There are also documented cases of vaginal stenosis after the complete embedding of a foreign object the patient has retained for several years. [10] In extreme cases, chronic inflammation of the surrounding tissue induced by retained foreign bodies can cause carcinogenesis as a result of oxidative and nitrative stress.[16]

Toxic shock syndrome (TSS) is associated most commonly with super-absorbent tampons, but the literature also documents it from other vaginal foreign material such as menstrual cups.[17] It occurs in 0.03 to 0.05 per 100000 individuals and has an overall mortality of 8%. Patients present with fever, rash, desquamation, and sepsis.[18] While the foreign material in the vagina does not directly cause TSS, it acts as a cofactor. The development of TSS requires a lack of antibodies to neutralize toxic shock syndrome toxin 1 and the presence of Staphylococcus aureus in the vaginal flora.[19] 

Sharp foreign bodies such as needles can migrate to the gastroenterological system, urologic system, and into the deep pelvis. All symptomatic patients with sharp foreign bodies should have a consultation with gynecology. In patients where removal is complicated, a stable needle can be managed conservatively with a close specialist follow-up.[8]

It is important to note that foreign bodies are a potential cause of infection in all ages. Infection should be on the differential, especially in patients with systemic symptoms, including fever and or tachycardia.

Clinical Significance

Retained vaginal foreign bodies are clinically significant, especially considering the risks that they pose. Foreign bodies are a nidus for infection and may also result in ulceration, bleeding, and fistula formation. Care is necessary when evaluating patients believed to have retained vaginal foreign bodies, and these objects require removal to reduce the risk of complications.

Enhancing Healthcare Team Outcomes

Potential vaginal foreign body cases require an interprofessional effort, including the primary clinician, gynecology specialists, and nursing. Examination for vaginal foreign bodies requires questions about topics that may be sensitive to the patient. It is also important to note the personal aspect of a genital exam. Thus, extra steps are necessary for all personnel involved in the patient’s care. The patient should receive a gown and blanket, and the blanket should be used during the exam to cover anatomy that does not need to be exposed. Providers should speak to the patient openly and refrain from judgmental remarks. A welcoming environment between the providers and patients will enhance medical care by minimizing barriers. It is paramount that privacy is offered, including asking the patient if she would like her visitors to leave the room, and that a chaperone is present. A female nurse can fill the chaperone role, and other nursing duties are covered below. Interprofessional cooperation and teamwork are essential to successful outcomes in these cases. [Level 5]

Nursing, Allied Health, and Interprofessional Team Monitoring

In patients who are awake during the examination, nursing staff should assess the patient throughout the exam for comfort. If sedation is used to perform any portion of the exam when evaluating for a foreign vaginal body, a nurse should monitor vital signs until the patient is awake and alert post-sedation.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Types of vaginal foreign bodies. Image courtesy S Bhimji MD

References

1.

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 Dec;30(6):620-625. [PubMed: 28669787]

2.

Anderson J, Paterek E. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 18, 2022. Flea Bites. [PubMed: 31082162]

3.

Abesamis MG, Taki N, Kaplan R. Uterine Body Stuffing Confirmed by Computed Tomography. Clin Pract Cases Emerg Med. 2017 Nov;1(4):365-369. [PMC free article: PMC5965216] [PubMed: 29849377]

4.

Wankhade VK, Chikhalkar BG. Body packing and intra-vaginal body pushing of cocaine: A case report. Leg Med (Tokyo). 2018 Mar;31:10-13. [PubMed: 29232651]

5.

Wu CC, Hsieh ML, Wang TM. Retained vaginal gauze with unusual complication: a case report. Changgeng Yi Xue Za Zhi. 1997 Mar;20(1):62-5. [PubMed: 9178596]

6.

Stricker T, Navratil F, Sennhauser FH. Vaginal foreign bodies. J Paediatr Child Health. 2004 Apr;40(4):205-7. [PubMed: 15009550]

7.

Smith YR, Berman DR, Quint EH. Premenarchal vaginal discharge: findings of procedures to rule out foreign bodies. J Pediatr Adolesc Gynecol. 2002 Aug;15(4):227-30. [PubMed: 12459229]

8.

He Y, Zhang W, Sun N, Feng G, Ni X, Song H. Experience of pediatric urogenital tract inserted objects: 10-year single-center study. J Pediatr Urol. 2019 Oct;15(5):554.e1-554.e8. [PubMed: 31301975]

9.

Nayak S, Witchel SF, Sanfilippo JS. Vaginal foreign body: a delayed diagnosis. J Pediatr Adolesc Gynecol. 2014 Dec;27(6):e127-9. [PubMed: 24656699]

10.

Nakib G, Calcaterra V, Pelizzo G. Longstanding Presence of a Vaginal Foreign Body (Battery): Severe Stenosis in a 13-Year-Old Girl. J Pediatr Adolesc Gynecol. 2017 Feb;30(1):e15-e18. [PubMed: 27614288]

11.

Lo TS, Jaili SB, Ibrahim R, Kao CC, Uy-Patrimonio MC. Ureterovaginal fistula: A complication of a vaginal foreign body. Taiwan J Obstet Gynecol. 2018 Feb;57(1):150-152. [PubMed: 29458888]

12.

Powers K, Grigorescu B, Lazarou G, Greston WM, Weber T. Neglected pessary causing a rectovaginal fistula: a case report. J Reprod Med. 2008 Mar;53(3):235-7. [PubMed: 18441734]

13.

Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Aug;19(8):1173-8. [PubMed: 18301852]

14.

Andrikopoulou M, Lazarou G. Rare case of neglected pessary presenting with concealed vaginal hemorrhage. Female Pelvic Med Reconstr Surg. 2015 Jan-Feb;21(1):e1-2. [PubMed: 25185620]

15.

Yan D, Shi Z, Wang L, Zhao X. Migration of a fractured ring IUD resulting in vesicovaginal fistula and vaginal calculus. Eur J Contracept Reprod Health Care. 2018 Oct;23(5):387-389. [PubMed: 30324812]

16.

Osman K, Abdellaoui B, Weyl B, Levêque J. [Uterine Carcinosarcoma induced by a vaginal foreign body: a case report and review]. J Gynecol Obstet Biol Reprod (Paris). 2013 Feb;42(1):91-4. [PubMed: 23062745]

17.

Mitchell MA, Bisch S, Arntfield S, Hosseini-Moghaddam SM. A confirmed case of toxic shock syndrome associated with the use of a menstrual cup. Can J Infect Dis Med Microbiol. 2015 Jul-Aug;26(4):218-20. [PMC free article: PMC4556184] [PubMed: 26361491]

18.

Berger S, Kunerl A, Wasmuth S, Tierno P, Wagner K, Brügger J. Menstrual toxic shock syndrome: case report and systematic review of the literature. Lancet Infect Dis. 2019 Sep;19(9):e313-e321. [PubMed: 31151811]

19.

Vostral S. Toxic shock syndrome, tampons and laboratory standard-setting. CMAJ. 2017 May 23;189(20):E726-E728. [PMC free article: PMC5436965] [PubMed: 28536130]

Disclosure: Jackie Anderson declares no relevant financial relationships with ineligible companies.

Disclosure: Elizabeth Paterek declares no relevant financial relationships with ineligible companies.

Vaginal Foreign Body Evaluation and Treatment – StatPearls

Continuing Education Activity

Vaginal foreign bodies present in female patients of all ages and a wide range of healthcare settings, including the emergency department, primary care office, gynecology office, and urology office. This activity is designed to inform the reader about vaginal foreign body treatment, removal, and management. It discusses both typical and atypical presentations, as well as complications. It also provides information on how to manage removal as well as how to image patients of various ages.

Objectives:

• Identify the anatomical structures of the vagina when evaluating for foreign bodies.

• Describe the equipment, personnel, preparation, and technique in regards to removing vaginal foreign bodies.

• Review the potential complications of vaginal foreign bodies.

• Explain interprofessional team strategies for improving care and treatment for vaginal foreign bodies and improve outcomes. Strategies will be reviewed to enhance communication with patients as well as removal strategies.

Access free multiple choice questions on this topic.

Introduction

Vaginal foreign bodies present in female patients of all ages and a wide range of healthcare settings, including the emergency department, primary care office, gynecology office, and urology office. The objects found differ among age groups. Toys, tissue paper, and household objects are the most common in pediatrics. In adult women, considerations include tampons, condoms, menstrual cups, and items used for sexual gratification. Elderly patients are at increased risk for retained medical devices such as pessaries.[1][2] Patient populations such as prisoners and drug traffickers may use the vaginal canal and uterus to hide illicit substances.[3][4] In postpartum patients with recurrent abdominal pain, pelvic abscess, bladder stones, irritable bladder, and retained surgical gauze merit consideration; however, this is an unusual complication due to patient safety initiatives involving the careful counting of surgical gauze and sponges during delivery.[5]

Patients may self-report a foreign body or may present with an array of symptoms, including pelvic pain, vaginal discharge, and vaginal bleeding. There is a broad differential diagnosis for these symptoms, including malignancy, sexually transmitted infections, candidal infections, and pregnancy. The most common presenting symptom in pediatric patients is vaginal bleeding or discharge.[6]

When evaluating a patient who suspects a vaginal foreign body, history should focus on the details surrounding the initial event; this includes timing, the suspected object, and symptoms of the abdomen, pelvis, and genitalia. History taking is imperative in all patient populations. Even in pediatric patients, the majority, 54% in one study, recall the event.[6] It is essential to consider sexual abuse as a cause for foreign bodies, especially in the pediatric population.

Anatomy and Physiology

The vagina is part of the female genitalia between the urethral meatus and anus. It is a muscular canal that serves as a connection between the external genitalia and the uterus. The vaginal opening has protection from the vulva, a structure comprised of the labia majora and labia minora. At the most proximal portion of the vagina is the cervix, a highly vascularized structure that guards the entrance to the uterus.

Indications

Evaluation for foreign bodies in the vaginal canal is necessary when patients present with a self-reported foreign body or complain of pelvic pain, vaginal bleeding, or discharge. It should also be a consideration in patients with urinary and rectal complaints. In pre-pubertal patients with vaginal bleeding or persistent vaginal discharge despite antimicrobial treatment, imaging, and a gynecology referral for examination under anesthesia should be considered by primary care and emergency physicians.[7]

The examination includes a genital exam, which may include a pelvic exam with a speculum. Imaging is an option if the diagnosis is unclear or complications are suspected; this includes X-ray, CT scan, MRI, and ultrasound. The choice of imaging will vary based on presenting symptoms and patient age. Transabdominal ultrasound is the preferred modality in pediatric patients due to the lack of radiation, increased availability, and decreased level of invasiveness when compared to a transvaginal ultrasound. It has an overall sensitivity of 81% and specificity of 53%, which improves when the foreign body is over 5 mm in size. This percentage is significantly better than X-ray, which may only detect 23% of foreign bodies.[1] CT imaging is an option if complications such as fistula or abscess are suspected. 

Contraindications

It is imperative to obtain consent before performing a pelvic examination. Examinations should not take place against patient wishes, as this can constitute assault. In pediatric patients or mentally handicapped patients, consent is necessary from their legal guardians. In these patients, an obstetrics and gynecology consult can be considered to perform an exam under sedation if there is a concern for patient distress. The majority of pediatric patients are manageable with same-day surgery.[8]

The clinician should not perform a pelvic exam if there is suspicion of rape or assault if the patient or guardian has any desire to press charges. In this case, defer the pelvic exam to a specialized investigation team, as introducing anything into the vulva or vagina, even sterile lubrication, can interfere with specimen collection. This approach is a critical consideration in the pediatric population if there is any suspicion for physical or sexual abuse.

Equipment

Several modalities are useful for assessment of the presence of a foreign body in the vagina, including a pelvic exam with or without anesthesia, ultrasonography, pelvic radiography, MRI, and vaginoscopy.[1] Many foreign bodies can be removed with forceps under direct visualization, though those in place for an extended period may require surgical intervention by a gynecologist.

Persistent discharge despite antimicrobial treatment should raise suspicion of a foreign body, and evaluation should take place.[7] It should also remain in the differential for pre-pubertal patients with vaginal bleeding despite a negative ultrasound. Additional radiographic imaging, ultrasonographic imaging, or examination under anesthesia may be required to rule out a foreign body.[9]

Extreme cases may require surgical intervention to remove foreign objects due to size, position, location, and other complicating factors. General anesthesia may be used to allow for full muscle relaxation and aid in foreign body removal.

Personnel

Genital evaluation should be performed with a member of the health care team at the bedside to act as a chaperone. This may occur in an outpatient office or in the Emergency Department. It is important to ask the patient if she prefers to have a female chaperone and to consider having at least one female staff member in the room during the examination. This health care team member, if qualified, can also act as an assistant during the pelvic exam by handing equipment to the provider performing the exam. 

In pediatric patients, sedation in the operating room may be considered. In these cases, the usual operating staff, including an anesthesiologist and gynecologist, are necessary. 

If ultrasonography is used to evaluate for a foreign body, an ultrasound technician may be required to perform a transabdominal or transvaginal ultrasound.

Preparation

For routine examination in adult patients, preparation for pelvic exams includes asking the patient to remove her lower garments and providing a gown and drape. Privacy is necessary during this step, and a chaperone during the exam is paramount. It is vital that the patient feels comfortable and non-threatened. A non-sterile, lubricated speculum is usable in non-pregnant patients, and a reliable light source should be used to enhance visibility. Culture swabs should be readily available at the bedside if vaginal discharge is reported or appreciated on an exam as foreign bodies are a nidus for infection. Forceps can be brought to the bedside to aid in the removal of foreign material. 

Complications

Retained vaginal foreign bodies pose risks. Indwelling foreign objects are niduses for infection; pelvic inflammation can result in infertility.[10] Additionally, compression on surrounding tissues can compromise blood flow resulting in necrosis, a complication that can pose its own sequela, including perforation and fistulas.[10][11] Rectovaginal and vesicovaginal fistulas often occur after foreign bodies have been in place for years. These include medically placed devices such as pessaries and fractured ring IUDs in addition to materials placed by patients. These patients may present with atypical symptoms, including frequent urinary tract infections, vesicle stones, vaginal bleeding, and rectal discharge or bleeding.[12][13][14][15]

Ulceration can also occur, especially if caustic objects are present in the vaginal vault, such as batteries.[10] There are also documented cases of vaginal stenosis after the complete embedding of a foreign object the patient has retained for several years.[10] In extreme cases, chronic inflammation of the surrounding tissue induced by retained foreign bodies can cause carcinogenesis as a result of oxidative and nitrative stress.[16]

Toxic shock syndrome (TSS) is associated most commonly with super-absorbent tampons, but the literature also documents it from other vaginal foreign material such as menstrual cups.[17] It occurs in 0.03 to 0.05 per 100000 individuals and has an overall mortality of 8%. Patients present with fever, rash, desquamation, and sepsis.[18] While the foreign material in the vagina does not directly cause TSS, it acts as a cofactor. The development of TSS requires a lack of antibodies to neutralize toxic shock syndrome toxin 1 and the presence of Staphylococcus aureus in the vaginal flora.[19] 

Sharp foreign bodies such as needles can migrate to the gastroenterological system, urologic system, and into the deep pelvis. All symptomatic patients with sharp foreign bodies should have a consultation with gynecology. In patients where removal is complicated, a stable needle can be managed conservatively with a close specialist follow-up.[8]

It is important to note that foreign bodies are a potential cause of infection in all ages. Infection should be on the differential, especially in patients with systemic symptoms, including fever and or tachycardia.

Clinical Significance

Retained vaginal foreign bodies are clinically significant, especially considering the risks that they pose. Foreign bodies are a nidus for infection and may also result in ulceration, bleeding, and fistula formation. Care is necessary when evaluating patients believed to have retained vaginal foreign bodies, and these objects require removal to reduce the risk of complications.

Enhancing Healthcare Team Outcomes

Potential vaginal foreign body cases require an interprofessional effort, including the primary clinician, gynecology specialists, and nursing. Examination for vaginal foreign bodies requires questions about topics that may be sensitive to the patient. It is also important to note the personal aspect of a genital exam. Thus, extra steps are necessary for all personnel involved in the patient’s care. The patient should receive a gown and blanket, and the blanket should be used during the exam to cover anatomy that does not need to be exposed. Providers should speak to the patient openly and refrain from judgmental remarks. A welcoming environment between the providers and patients will enhance medical care by minimizing barriers. It is paramount that privacy is offered, including asking the patient if she would like her visitors to leave the room, and that a chaperone is present. A female nurse can fill the chaperone role, and other nursing duties are covered below. Interprofessional cooperation and teamwork are essential to successful outcomes in these cases. [Level 5]

Nursing, Allied Health, and Interprofessional Team Monitoring

In patients who are awake during the examination, nursing staff should assess the patient throughout the exam for comfort. If sedation is used to perform any portion of the exam when evaluating for a foreign vaginal body, a nurse should monitor vital signs until the patient is awake and alert post-sedation.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Types of vaginal foreign bodies. Image courtesy S Bhimji MD

References

1.

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 Dec;30(6):620-625. [PubMed: 28669787]

2.

Anderson J, Paterek E. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 18, 2022. Flea Bites. [PubMed: 31082162]

3.

Abesamis MG, Taki N, Kaplan R. Uterine Body Stuffing Confirmed by Computed Tomography. Clin Pract Cases Emerg Med. 2017 Nov;1(4):365-369. [PMC free article: PMC5965216] [PubMed: 29849377]

4.

Wankhade VK, Chikhalkar BG. Body packing and intra-vaginal body pushing of cocaine: A case report. Leg Med (Tokyo). 2018 Mar;31:10-13. [PubMed: 29232651]

5.

Wu CC, Hsieh ML, Wang TM. Retained vaginal gauze with unusual complication: a case report. Changgeng Yi Xue Za Zhi. 1997 Mar;20(1):62-5. [PubMed: 9178596]

6.

Stricker T, Navratil F, Sennhauser FH. Vaginal foreign bodies. J Paediatr Child Health. 2004 Apr;40(4):205-7. [PubMed: 15009550]

7.

Smith YR, Berman DR, Quint EH. Premenarchal vaginal discharge: findings of procedures to rule out foreign bodies. J Pediatr Adolesc Gynecol. 2002 Aug;15(4):227-30. [PubMed: 12459229]

8.

He Y, Zhang W, Sun N, Feng G, Ni X, Song H. Experience of pediatric urogenital tract inserted objects: 10-year single-center study. J Pediatr Urol. 2019 Oct;15(5):554.e1-554.e8. [PubMed: 31301975]

9.

Nayak S, Witchel SF, Sanfilippo JS. Vaginal foreign body: a delayed diagnosis. J Pediatr Adolesc Gynecol. 2014 Dec;27(6):e127-9. [PubMed: 24656699]

10.

Nakib G, Calcaterra V, Pelizzo G. Longstanding Presence of a Vaginal Foreign Body (Battery): Severe Stenosis in a 13-Year-Old Girl. J Pediatr Adolesc Gynecol. 2017 Feb;30(1):e15-e18. [PubMed: 27614288]

11.

Lo TS, Jaili SB, Ibrahim R, Kao CC, Uy-Patrimonio MC. Ureterovaginal fistula: A complication of a vaginal foreign body. Taiwan J Obstet Gynecol. 2018 Feb;57(1):150-152. [PubMed: 29458888]

12.

Powers K, Grigorescu B, Lazarou G, Greston WM, Weber T. Neglected pessary causing a rectovaginal fistula: a case report. J Reprod Med. 2008 Mar;53(3):235-7. [PubMed: 18441734]

13.

Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Aug;19(8):1173-8. [PubMed: 18301852]

14.

Andrikopoulou M, Lazarou G. Rare case of neglected pessary presenting with concealed vaginal hemorrhage. Female Pelvic Med Reconstr Surg. 2015 Jan-Feb;21(1):e1-2. [PubMed: 25185620]

15.

Yan D, Shi Z, Wang L, Zhao X. Migration of a fractured ring IUD resulting in vesicovaginal fistula and vaginal calculus. Eur J Contracept Reprod Health Care. 2018 Oct;23(5):387-389. [PubMed: 30324812]

16.

Osman K, Abdellaoui B, Weyl B, Levêque J. [Uterine Carcinosarcoma induced by a vaginal foreign body: a case report and review]. J Gynecol Obstet Biol Reprod (Paris). 2013 Feb;42(1):91-4. [PubMed: 23062745]

17.

Mitchell MA, Bisch S, Arntfield S, Hosseini-Moghaddam SM. A confirmed case of toxic shock syndrome associated with the use of a menstrual cup. Can J Infect Dis Med Microbiol. 2015 Jul-Aug;26(4):218-20. [PMC free article: PMC4556184] [PubMed: 26361491]

18.

Berger S, Kunerl A, Wasmuth S, Tierno P, Wagner K, Brügger J. Menstrual toxic shock syndrome: case report and systematic review of the literature. Lancet Infect Dis. 2019 Sep;19(9):e313-e321. [PubMed: 31151811]

19.

Vostral S. Toxic shock syndrome, tampons and laboratory standard-setting. CMAJ. 2017 May 23;189(20):E726-E728. [PMC free article: PMC5436965] [PubMed: 28536130]

Disclosure: Jackie Anderson declares no relevant financial relationships with ineligible companies.

Disclosure: Elizabeth Paterek declares no relevant financial relationships with ineligible companies.

An ambulance doctor explained why stopping the blood with tampons can kill a person

• Health

Those mobilized within the NWO are advised to take a first aid kit with them, and they recommend putting unexpected things in it – sanitary tampons and pads. What will happen if you try to stop the blood with tampons, the doctor explains.

November 1, 2022

Source:

unsplash.com

Proper first aid is life saved, doctors say. Therefore, it is so important to know what can be done, and what actions should be abandoned once and for all. All mobilized soldiers need to take a first aid kit with them, which will help out in an emergency.

And one of those situations is stopping the bleeding. On the Web, they began to actively promote that feminine hygiene products, that is, ordinary tampons, will help stop the blood. Like, the last ones generally need to plug the wounds. In fact, you can’t do it exactly like that, says ambulance doctor Dmitry Molodoy.

— I have been working in an ambulance for ten years, and despite the fact that I am a civilian doctor, I have experience in stopping bleeding. So, as you guessed, our main task in stopping the bleeding is quite obvious: the blood must stop. And here hygiene products will definitely not help us, the doctor says.

See also

After all, pads and tampons were designed to absorb blood. It was absorbed, not stopped . The same tampon can “pick up” up to half a liter of blood.

— Now imagine the situation: we have a shrapnel wound, that is, this is a lot of small wounds. You take 5-8 tampons and plug each hole tightly with them. The tampon begins to do its job: to absorb blood. Each of them is filled (remember that one can absorb up to 0.5 liters). Simple arithmetic is enough to calculate that the total blood loss will be somewhere around 4 liters , Dmitry Molodoy explains.

And that’s all, this is where the medical care can be completed. A person has about 5 liters of blood, thanks to tampons he has already lost 4. The remaining liter of blood in the body will definitely not be able to support his life. In simple terms, the wounded will die.

To stop bleeding:

• hemostatic sponges,

• ordinary cotton-gauze swabs, with which we tightly pack the wound.

If this does not stop the bleeding, then an arterial tourniquet comes to the rescue. And it will be good if a person practices in advance, looks at how to apply everything correctly, in what order, how to bandage and tighten.

See also

– By the way, gaskets won’t help either. It is said that they help out well when the feet are wet. You can put the lining in the boot over the wet insole. It will absorb everything, will not let your feet get cold. Here I approve, use this advice,” the expert concluded.

What should I put in my first aid kit for emergencies? How many harnesses? What medicines? And what exactly is not worth taking? Ekaterina Sinitsina, an ambulance paramedic, spoke about this – you can read the text HERE.

Text author:Sofya Khromova

Anterior and posterior nasal tamponade – what is the procedure, how is nasal tamponade performed in case of bleeding

Nasal tamponade is a medical procedure performed to stop massive nosebleeds. As a rule, anterior epistaxis, the source of which is the vessels of the Kisselbach bundle in the region of the anterior part of the nasal septum, is mild, it can be easily stopped by pressing or using hemostatic drugs. Posterior bleeding from the nose is associated with a violation of the integrity of larger vessels located closer to the pharynx, it is abundant, sometimes profuse, and leads to the loss of a large volume of blood. Incessant anterior and all cases of posterior nosebleeds require nasal tamponade – anterior or posterior.

Species

Depending on the type of bleeding and the technique of the doctor’s manipulations, there are anterior and posterior nasal tamponade.

Anterior nasal packing

Technically simple procedure, used frequently.

The mucous membrane of the nasal cavity is treated with an anesthetic solution (usually lidocaine or dicaine). When the drug works (after 3-5 minutes), tamponade begins. As a rule, the loop method according to Mikulich is used. For this, a gauze turunda is prepared, the width of which is 1.5-2 cm, the length is 55-70 cm. It is impregnated with a solution of 3% hydrogen peroxide, a hemostatic agent or an indifferent ointment, for example, petroleum jelly. With cranked tweezers, the turunda is captured at a distance of 6-7 cm from the end and inserted into the nasal cavity on the side of bleeding as deep as possible, to the very choanae. The next section of the turunda is intercepted with tweezers, and also injected into the nose. Thus, the entire turunda, which fills half of the nose, is tightly laid – from the choana to the vestibule. If the bleeding is bilateral, conduct anterior nasal tamponade of the other half of the nose. Apply a sling bandage.

The tampons can stay in the nose for 3-6 days depending on whether the bleeding has stopped. From the third to the sixth day, turundas are treated daily with a solution of an antibacterial drug.

Before removal, swabs are soaked in a solution of 3% hydrogen peroxide – this will facilitate their removal.

An alternative to anterior nasal tamponade for nosebleeds according to Mikulicz are sterilized cotton-gauze swabs. They densely fill the nasal cavity to ensure clamping of the damaged blood vessel. This is also an effective method, and it is more comfortable for the patient.

Posterior packing

With abundant, long-lasting nosebleeds, posterior nasal tamponade is used. It is carried out by an otolaryngologist who is well acquainted with the technique.

A Nelaton soft catheter, previously lubricated with petroleum jelly, is inserted into the patient’s nasal cavity. When the end of this catheter is shown in the pharynx, it is grasped with tweezers and removed through the mouth. A previously prepared sterile tampon is tied to this end – a ball the size of a walnut, made of cotton covered with gauze, tied crosswise with silk thread. One of the four ends of the thread is cut off, with two – the ball is tied to the catheter removed from the patient’s mouth, then the catheter is pulled up by the nasal end and the tampon threads are passed into the nasal cavity and out through the nostril.