N Malhotra, C Chanana, S Lal
foreign body, vaginal discharge
N Malhotra, C Chanana, S Lal. Forgotten Vaginal Pessary Discovered after 30 years. The Internet Journal of Gynecology and Obstetrics. 2006 Volume 6 Number 2.
Foreign body in vagina is common in young children such an event in adults is rare. We present a case of a long forgotten vaginal foreign body (pessary) detected 30 years after its insertion in a 78 year old lady. The patient presented with malodorous discharge pervaginum. The pessary was retrieved under sedation. The patient has been asymptomatic thereafter.
A long forgotten vaginal foreign body is a rare entity, particularly when detected 30 years after its insertion. The associated erosion and granulation over the vagina make its detection difficult. A high index of suspicion can help solve dilemma posed by such foreign bodies in women's body who present with foul smelling bloody discharge.
A 78–year-old, para 6, postmenopausal women presented to us in the outpatient department, with dysuria and malodorous vaginal discharge for the last four years. She had senile dementia and suffered from supraventricular tachycardia. Per-speculum examination revealed shortened vagina with a rim of granulation tissue approximately 3 cm beyond the introitus. Muco-purulent discharge was seen coming from the narrowed opening above this rim and the cervix was not visualised. Vaginal examination suggested a ring of granulation tissue at the middle of the vagina, beyond which only a finger could be introduced to feel the atrophic cervix pushed behind the pubic symphysis. Culture of vaginal discharge for actinomycosis was negative.
Trans-perineal sonography suggested a ring shaped foreign body around 4 cm in diameter inside the vagina. On further interrogation she recalled being examined by a gynaecologist 30 years back, who applied a ring pessary for pelvic relaxation in early postmenopausal years. Examination under sedation (intravenous midazolam, 1mg) confirmed it to be a black coloured ring pessary under the granulation tissue in the vagina. The pessary was dislodged with difficulty and was removed under traction maintained by a Kocher's clamp. There was minimal oozing from the vaginal bed. The vagina was irrigated copiously with povidine-iodine and she was given a combination of ciprofloxacin and tinidazole for seven days. Follow-up evaluation a week later revealed minimal discharge and scarring of the vagina.
There have been cases of forgotten foreign bodies in vagina in adults (1,2,3,4) but most of them are in children (5,6). Various objects that have found way into vagina include toys, metallic glasses, screws, hair sprays, plastic covers and drinking glass. Various complications namely fistula formation (3) and bowel obstruction (4) have been reported with retained foreign body in vagina. Retrieval of these foreign bodies which may be deeply impacted and associated with erosion and granulation tissue, can be difficult. Also these have to be distinguished from more serious conditions as carcinoma cervix.
This case draws attention to the fact that foul–smelling vaginal discharge in elderly women should arouse suspicion of a foreign body. Such women do not consult their physician for follow-up, either because they remain unaware of the presence of a foreign body in the vagina or have completely forgotten it, as in our case.
Dr Charu Chanana 91, Pocket B, Sukhdev Vihar, New Delhi, India-110025 Ph-+91-9810482629 e-mail:firstname.lastname@example.org