Child sexual abuse unmasked due to vaginal foreign body: case review

Vaginal foreign body (VFB) can be a routine presentation to a pediatric unit, especially with associated vaginal discharge. Although it can be rare, this case series highlights that child sexual abuse (CSA) should not be ignored as a possibility when such a presentation is investigated. In the first case, an 11-year-old school girl presented with vaginal discharge and urinary symptoms, which was revealed to be due to a vesico-vaginal fistula secondary to an intra-vaginal foreign body, which was a plastic cap. Further investigation revealed that she had undergone vaginal penetration since the age of 6 years by two older male relatives. However, she was unaware how a plastic object came in to being inside her vagina. In the second case, a polythene bag was retrieved from the vagina of a 15 and a half year-old, pubertal female with an intellectually disability who presented with a 3-4-month history of vaginal discharge. Further investigation revealed that she had been vaginally penetrated on multiple occasions by her elder brother, who used polythene bags instead of condoms. Such a bag had been retained in her vagina leading to the vaginal discharge. VFB with or without genito-urinary symptoms is a red flag to identify sexual abuse among children, especially with intellectual disabilities. Although literature reports a wide variety of vaginal foreign bodies, there had been no reports of polythene bags used in place of condoms which were retrieved from a vagina of a CSA victim.