Of bizarre foreign objects retained in the genital tract

One of the things that made me dislike the paediatric emergency department early on in my profession was having to attend to children with foreign bodies in orifices that had no business having them in the first place.

In medical school, we knew when it was the bean harvesting season because every single day, there would be a toddler with a bean up their nose. First, try imagining how tiny baby’s nostrils are, then picture a bean up there. I wouldn’t even want to know how it got stuffed in.

The baby has no idea that the bean is an organic item, which after soaking up the moisture produced by the nasal secretions, doubles in size. From beads to cockroaches, toy parts to coins, I was sworn off the Ear, Nose and Throat (ENT) specialty for life.

Babies may be excused for lack of awareness. However, it is amazing the awkward situations adults will put themselves in, knowingly or unknowingly, that result in foreign objects in the most unexpected of places.

A few years ago, a surgical colleague shared an x-ray image of a male patient, showing an entire spotlight torch pushed up his rectum. What came to mind immediately was sexual assault. However, it was clarified that this was purely voluntary, in pursuit of sexual pleasure. I certainly did not want to be the surgeon on the table that night!

Sexual escapades resulting in such unexpected accidents in both men and women are not as uncommon as we like to think. Women have turned up in the emergency room for failure to locate objects that went in and didn’t come out of the vaginal cavity.

Common objects include tampons, menstrual cups, condoms, tissue paper, medical devices such as pessaries and commercial sex toys. Less common findings include illicit drugs for smuggling purposes, and rarely, a forgotten surgical gauze. Common household items such as buttons, small coins and beads have all be reported.

Special attention is drawn to women and girls with possible intellectual disabilities and mental illness, who may insert foreign objects vaginally and not be able to report it. This may be easily missed by their caregivers. These objects may also be present as a result of sexual abuse!

Then there are the unanticipated ones. Recently there was a craze by women in Kenya cleansing their vaginas with yoni pearls. Thankfully this harmful wave seems to be passing. A few women ended up needing help removing the offending item, days after they stashed them up there. Then there is the utterly morbid. The lost carrots stories by gynaecologists are a dime a dozen. Two years ago, a colleague published a case in one of the medical journals, of finding four three-inch iron nails in a woman who reported to the hospital with complains of vaginal pain and bleeding. The circumstances leading up to the situation remained unclear.

A colleague recently reported of a patient with embedded shards of glass that had stayed in place for years after a test tube fragmented in the vagina. It had led to the vaginal walls being distorted by scar tissue that had buried the shards in an attempt at healing the injured walls.

Three years ago, I had to call in the help of a urogynaecologist on the operating table when we finally located a long-lost copper intrauterine device that had made its way from the uterus into the bladder, 13 years previously. It was removed from the bladder in fragmented pieces. How this was never seen in multiple ultrasound scans in the subsequent pregnancies was beyond explanation. She suffered repeat urinary tract infections over the years without this being recognised as the cause.

Unfortunately, in our setting, crude weapons used in procuring unsafe abortions by quacks are oftentimes found in the vagina and uterus. These include knitting needles, wire hangers and even crude sticks. Most of the time, the women come with severe injuries to not only the vagina but also the uterus, bladder and intestines beyond.

Foreign bodies may be identified and removed early on when they cause pain and bleeding. Sometimes these may require removal under anaesthesia when they are sharp, or awkwardly positioned in order to minimise further injury and allow the gynaecologist to explore possible additional injury to the surrounding urethra, uterus, and rectum.

Items that have been in the vagina for a long time result in local infection, manifesting as offensive vagina discharge over the period. Left unattended, they may develop into a vaginolith. This is the body’s attempt to encase the offending item in scar tissue to prevent recurrent infection, resulting in a firm, almost stone-like mass in the wall of the vagina.

Infection and healing of the vaginal wall result in inflammation that eventually simmers down to scar tissue formation, especially when the foreign body is not made up of material that can decompose. Scar tissues distorts the normal anatomy of the vaginal walls, causing tightening and loss of elasticity. This results in painful sex, a common symptom that makes the patient seek care.

In some instances, the inflammation may damage the vaginal wall, invading the structures that intimately lie adjacent to the vagina, resulting in fistula formation. The patient may then present months to years later, with leaking of urine or stool vaginally. These require intensive surgical procedures in order to repair the damage. This may happen as multiple stepwise surgical repairs, done over a period of months.

It is important for one to seek help as soon as possible once they realise they may have a foreign object in the vaginal cavity. This enables one to get the medical help they need, to remove the item in a timely fashion, avoiding long-term complications. It is also critical to give your doctor the correct history of events leading up to the retention of the foreign body in order to avoid misdiagnosis and incorrect treatment. These foreign bodies may be mistaken for tumours, genital tract TB and even anatomical malformations; sending us on a wild goose chase, with wrongful interventions. It is also extremely important as medical personnel to avoid judgement and shaming because the patient is already facing an extremely difficult situation. They need support, empathy and reassurance.

Dr Bosire is an obstetrician/ gynaecologist