Vaginal foreign body

This prepubertal girl likely has a vaginal foreign body, a common cause of vaginitis in this patient population. Toilet paper is a common vaginal foreign body; other retained objects include small toys and rubber bands. When the foreign body becomes retained in the vagina, it irritates the vaginal mucosa and results in intermittent vaginal bleeding and a chronic, malodorous vaginal discharge. Patients typically have no vulvar symptoms (eg, pruritus, erythema, lacerations) and an otherwise normal examination.

Vaginal foreign bodies are typically diagnosed clinically on external pelvic examination with the patient in the knee-chest or frog-leg position. Objects that are easily visualized can be removed in the office with either warm saline irrigation or a cotton swab. For patients who cannot tolerate the procedure or in whom the foreign body cannot be easily removed, vaginoscopy under general anesthesia is performed.