Vaginal foreign body in the pediatric patient: A systematic review

Abstract

Background

Vaginal foreign bodies represent a clinical and diagnostical challenge in pediatric gynecology. Several case reports, case series and retrospective studies have been published, highlighting rare or complex cases. A comprehensive systematic review is lacking.

Methods

Published English-language articles on vaginal foreign objects in patients aged 16 years and younger, with full-text availability were included. Articles on adult patients and patients with an object migrating from the abdominal cavity into the vagina were excluded.

Results

Out of the 215 screened articles 75 were included, comprising a total of 522 patients. The age ranged from 6 months to 16 years, with an average of 6 years and 3 months. The presenting symptoms were documented in 340 patients, with the two most common being vaginal bleeding (n = 172) and vaginal discharge (n = 134). Toilet paper or tissue was the most common object, in 155 out of 447 patients. Ultrasonography was the most utilized diagnostic method, with a sensitivity of 79.9 %. Radiography showed more false-negative than true-positive results, with a sensitivity of 33.3 %. Complications were reported in 35 patients. Evidence of sexual abuse was found in a small group of 16 patients. Vaginoscopy under sedation was the most frequently used therapeutic approach.

Conclusion

A swift and accurate diagnosis is crucial, with clinical examination and ultrasonography playing pivotal roles. Vaginoscopy is the gold standard for definitive diagnosis and therapy. Attention should be given to a potential context of sexual abuse.