Vaginal foreign body: a delayed diagnosis

To describe a case of prolonged vaginal bleeding in a prepubertal girl. Review of medical record and literature search.

A 7-year-old female was referred to our pediatric and adolescent gynecologic clinic for evaluation of vaginal bleeding and ovarian cyst on ultrasonography. Her parents denied any history of trauma or sexual abuse. Initial evaluation revealed pre-pubertal luteinizing hormone and follicle stimulating hormone levels, and follow-up ultrasonography revealed normal pre-pubertal pelvic anatomy. However, a skeletal survey, which was obtained to assess for the presence of skeletal fibrous dysplasia, revealed a metal spring in the vagina. The patient ultimately underwent an exam under anesthesia and vaginoscopy with removal of 3 foreign bodies, with subsequent termination of symptoms.

In cases of pre-pubertal vaginal bleeding, the possibility of vaginal foreign body should not be excluded despite normal sonographic imaging. If clinical suspicion for a vaginal foreign body persists, additional imaging modalities or exam under anesthesia should be considered.