Foreign Body in the Vagina

Common objects and who they affect

Adults and teens

• Tampons: by far the most common. A tampon can be forgotten at the end of a period, pushed high during sex, or a second one inserted on top of the first. Strings can tuck up behind the cervix.
• Condoms: can slip off during sex and stay in the vagina.
• Menstrual cups and discs: may sit high and be hard to grasp, particularly a disc tucked behind the pubic bone.
• Contraceptive sponges, diaphragms and vaginal rings.
• Pessaries: support devices for pelvic organ prolapse. If not removed and cleaned on schedule, they can embed in the vaginal wall and cause ulcers or a fistula.
• Objects used during sex, or objects inserted by someone else.

Children

In girls before puberty, a vaginal foreign body is a common cause of persistent, smelly or bloody discharge. The usual culprit is toilet paper. Small toys, beads, coins and crayons also turn up. Children often do not remember or say what happened. Most cases are innocent exploration, but doctors will gently consider the possibility of sexual abuse, especially if there are other signs.

Symptoms of a vaginal foreign body

An object left in place for more than a day or so lets bacteria multiply. The common symptoms are:

• Foul or rotten-smelling vaginal discharge, often brown, gray, green or yellow
• Spotting or bleeding between periods
• Itching, soreness or redness of the vulva and vagina
• Discomfort in the pelvis or a feeling that something is there
• Burning when passing urine, from nearby irritation
• Pain during sex

A forgotten tampon may cause no symptoms other than a strong smell. Someone who has used tampons for years may not feel a retained one at all.

Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare reaction to toxins made by Staphylococcus aureus or Streptococcus bacteria. Super-absorbent tampons and items left in place for a long time raise the risk. Symptoms start suddenly:

• high fever
• a flat red rash like sunburn, later peeling on the palms and soles
• vomiting, diarrhea and muscle aches
• dizziness, fainting or confusion from low blood pressure

TSS can progress to organ failure within hours. Remove the object if you can do so immediately, and call 911 or your local emergency number.

How to remove a stuck tampon or object at home

You can try once or twice if the object is soft and smooth and you have no fever or severe pain.

1. Wash your hands and trim long nails.
2. Empty your bladder.
3. Squat, or sit on the toilet with your knees apart, or stand with one foot raised on the edge of the bath.
4. Bear down gently, as if passing a bowel movement. This brings the cervix and the object lower.
5. Slide one or two fingers into the vagina and sweep around the cervix, which feels firm like the tip of a nose. A tampon often sits in the space behind or beside it.
6. Grip the object between two fingers and pull it out slowly.
7. For a menstrual cup, pinch the base to break the seal before pulling.

Stop and seek help if you cannot reach the object, it breaks apart, it is sharp, or you feel pain. Do not use tweezers, hooks or other tools, which can scratch the vaginal wall. Asking for help is common and nothing to be embarrassed about: clinicians remove retained tampons routinely.

Diagnosis

A doctor or nurse will ask what might have been inserted and when, and about fever, pain and discharge. A speculum examination usually finds the object straight away.

• In adults, a swab may be taken if the discharge persists after removal.
• In children, the examination is done gently with the child lying in a "frog-leg" or knee-chest position, with a parent present. Warm saline irrigation can flush out toilet paper. If the object cannot be seen or removed, an examination under brief anesthesia (vaginoscopy) is done. An ultrasound or X-ray can show metal or plastic objects but not paper.
• For long-retained objects, doctors check for ulcers, scarring or a fistula (an abnormal connection to the bladder or bowel).

Treatment

Removal

Most objects are removed in the clinic in a few minutes using forceps through a speculum. Tampons are usually placed straight into a bag because of the smell. Embedded pessaries or sharp objects may need removal in an operating room.

After removal

• The discharge and odor usually clear within 2 to 3 days without treatment, as the vagina's normal bacteria recover.
• Antibiotics are used if there are signs of spreading infection, such as fever, pelvic pain or tenderness, or if a swab shows an infection such as bacterial vaginosis.
• Avoid douching. It disturbs the vaginal balance and does not speed recovery.
• Ulcers from a pessary heal with vaginal estrogen cream and a break from the device.
• Anyone treated for TSS is advised not to use tampons again, because it can recur.

Complications

• Vaginal infection and inflammation (vaginitis)
• Toxic shock syndrome, rare but serious
• Spread of infection to the uterus and tubes (pelvic inflammatory disease), uncommon
• Ulceration and scarring from long-retained hard objects
• Fistula to the bladder or rectum, very rare, mostly after pessaries or objects retained for months

Prevention

• Use the lowest-absorbency tampon that manages your flow, and change it every 4 to 8 hours.
• Never insert a new tampon without checking the old one is out.
• Use a pad overnight or at the end of a period if you tend to forget.
• Check that a condom is intact and still on after sex.
• Keep a set schedule for pessary checks and cleaning.
• Teach young children to wipe gently and not to put things inside their bodies, and supervise toilet paper use.

Frequently asked questions

What are the symptoms of a forgotten tampon?

The main sign is a strong, unpleasant smell with brown, gray, green or yellow discharge. Some people have itching, spotting, pelvic discomfort or burning on urination. A sudden high fever, rash, vomiting or dizziness may signal toxic shock syndrome and needs emergency care.

How long can a tampon stay in safely?

The FDA advises changing tampons every 4 to 8 hours and never leaving one in for more than 8 hours. The longer a tampon stays in, the more bacteria grow and the higher the small risk of toxic shock syndrome.

Can a tampon get lost inside you?

No. The vagina is closed at the top by the cervix, whose opening is far too small for a tampon to pass. A tampon can be pushed high and tucked beside the cervix, which makes it hard to reach, but it cannot travel into the uterus or belly.

Who removes a stuck tampon?

A primary care doctor, gynecologist, nurse practitioner, urgent care clinic or ER can all remove one. It takes a few minutes with a speculum and is not usually painful. Go to the ER if you have fever, vomiting, a rash or feel faint.

Why does a child have smelly vaginal discharge?

In young girls, a foreign body such as toilet paper is a common cause of persistent smelly or blood-stained discharge. Poor hygiene, irritation from soaps, pinworms and infections are other causes. A doctor can examine gently and flush the vagina with warm saline if needed.

Will the smell go away after removing a tampon?

Usually, yes. The odor and discharge generally clear within 2 to 3 days as the vagina's normal balance returns. If smell, discharge or pain persists after that, or you develop fever, see a doctor for a swab and possible treatment.