vaginal foreign body
Introduction
Vaginal foreign body introduction Vaginal foreign body mainly manifests as increased vaginal secretions and infection, long-term retention can not be removed, can cause genitourinary tract spasm, vaginal ulcers, pelvic abscess, stones, etc., easily lead to misdiagnosis, giving patients a great pain in the spirit and body. basic knowledge The proportion of illness: 0.005%-0.008% (probability of female disease 0.3%) Susceptible people: women Mode of infection: non-infectious Complications: urinary fistula, fecal fistula, edema, vaginitis, vulvitis, pelvic abscess, peritonitis, septic shock, sepsis
Cause
Vaginal foreign body cause
(1) Causes of the disease
1. Source of vaginal foreign body
(1) Foreign objects are stuffed by others: such as cotton balls and gauze left over during surgery or treatment; for sexual stimulation, glasses, gin, wine bottles, metal jewelry boxes, etc. are stuffed into the vagina by sexual partners.
(2) Self-insertion: common in infants and young children out of curiosity or attempt to relieve vaginal itching, etc., to insert foreign bodies into the vagina, 9 cases of vaginal foreign bodies reported by Ding Shuzhen, aged 3 to 10 years old, all of which are mentally normal, of which 3 cases of children with similar age were inserted into the vagina; 2 cases were inserted into the vagina by mentally ill adults; 2 cases were inserted by themselves; 2 cases were unexplained.
2. Vaginal foreign body classification
There are many kinds of foreign objects that are mistaken into the vagina of young girls. Common ones are: hairpin, matchstick, peanut, corn, soybean, wheat, bicycle ball, cigarette filter, small stone, plastic cap, hemp stalk, pin, mother and child. Buckles, short plastic ropes, glass ampoules, metal perfume caps, etc. Adults are looking for sexual stimuli to put cucumbers, oranges, onions, perfume bottles, penis molds, etc. into the vagina, eventually unable to remove, or negligently contraceptives Forgotten in the vagina.
(two) pathogenesis
1. Insert foreign body for therapeutic purposes: such as gauze left after vaginal surgery, used for compression or hemostasis; patients with uterine prolapse in the vagina for uterine prolapse, when not taken out for a long time, leading to changes in vaginal flora and acute Inflammation.
2. Vaginal foreign body for contraception: Leave a condom, vaginal diaphragm, cervical cap, etc. in the vagina.
3. For abortion or induction of labor: The folk "sit medicine" can cause corrosive effects on the vaginal mucosa. Some unmarried pregnant girls self-abortion, put various foreign objects into the vagina.
4. Sexual stimulation: Sexual partners or self-insertion of various foreign bodies into the vagina, more likely to occur in drunkenness, more common in women of childbearing age also occur in older women, Asrtid Novak reported vaginal foreign body in 3 elderly women, one of them At the age of 81, she was admitted to the hospital due to vaginal pain. She took a plastic penis-like foreign body from her vagina. She admitted that she used her to masturbate 1 or 2 times a week. Another 69-year-old woman had a glass of wine in her vagina for 7 years. The former husband was replaced by a wine glass because she could not have sexual intercourse. Afterwards, the couple failed to take it out, and her husband forbade her to seek medical treatment. She did not come to the doctor until her husband died. After the incision, the glass could not be taken out completely. Take it one by one.
5. Foreign bodies invade the genital tract from other parts.
Prevention
Vaginal foreign body prevention
For patients with vaginal bleeding, increased secretions, vaginal foreign body sensation and urinary urgency, especially young girls should carefully identify the cause, actively treat, and prevent complications.
4 to 8 years old, the children in this period began to contact the society, more opportunities for independent action, increased curiosity and curiosity. In view of the above characteristics, we should guide parents to pay more attention to strengthening prevention, so as not to let go of their eyes, to stop their risky behaviors at any time, to prevent accidents, to strengthen education for children, and to strengthen the ability to distinguish; 2 to 3 years old children, began to walk The contact with the external environment is gradually increasing, the imitation power is constantly increasing, and sometimes the foreign body can be stuffed into the vagina due to the child's curiosity. Therefore, teach parents to let the little girl wear long pants. At the same time, parents should give appropriate early sex education to children. According to the age and ability of children, they can instill sexual knowledge. If you tell the difference between boys and girls, you can't drop your pants before strangers, and you can't just put foreign objects into your body. Parents should not try to pick up the vaginal foreign body once, so as not to increase the difficulty of taking the doctor.
Complication
Vaginal foreign body complications Complications urinary fistula fecal edema vaginitis vulvitis pelvic abscess peritonitis septic shock sepsis
The most common complications are:
1. Vaginal fistula: Long-term existence of solid foreign bodies in the vagina will compress local tissues, cause ischemic necrosis, and even invade the bladder or rectum, forming vaginal fistula, including urinary fistula and feces, causing urine or feces to be excreted through the vagina.
(1) urinary fistula: The main clinical manifestation is leakage of urine. The form of leakage of urine varies with the location of the leak. For example, vesicovaginal fistula usually cannot control urination, urine is discharged from the vagina; urethral fistula is only leaked when the bladder is full. Urine; one side of the ureteral vaginal fistula can still enter the bladder due to the healthy side of the urine, while still urinating while leaking urine; the sinus sinus sinus does not leak urine when taking a certain position, and leaks urine after changing the body position.
In the urinary fistula caused by vaginal foreign body, the most common is vaginal vagina, Hu Jianming reported vaginal foreign body caused by bladder vaginal fistula huge bladder stones in 1 case, the patient was 21 years old, vaginal leakage for 6 years, 6 years ago menarche when a plastic The shampoo bottle cap is inserted into the vagina, trying to prevent menstrual blood outflow, and then gradually appear urinary frequency urgency, vaginal leakage, etc. Physical examination: about 3cm × 3cm plastic foreign body is seen in the vagina, the bottle cap is crossed across the anterior wall of the vagina and the bladder wall is buried. Into the bladder, the vaginal anterior wall and the external urethral opening up, urine oozing from the bottle cap, X-ray abdominal plain film showing the bladder area see 15cm × 15cm high density shadow, diagnosis: 1 vaginal foreign body; 2 vaginal fistula; 3 bladder Calculus, underwent epidural anesthesia, bladder incision and vaginal hernia repair, open the bladder to see mucosal congestion and edema, see 15cm × 15cm large stones in the bladder, with the cap as the core and block the urethra, postoperative He was discharged from hospital in 3 weeks and was followed up for 4 years without abnormalities.
In recent years, Japan has reported 6 cases of vaginal fistula caused by vaginal foreign body. One of them is to put the gelatin can into the vagina. The bottle cap cannot be taken out together, and the bladder vagina is finally combined. The patient has a vaginal fistula through the abdomen after 2 months. Repair.
Ureteral vaginal fistula is relatively rare, Binstock reported a case of vaginal fistula caused by vaginal foreign body with ureterovaginal fistula, 52 years old, 5 years ago menopause, due to leucorrhea odor and vaginal itching treatment, examination found that the posterior vaginal wall near the rectal vaginal septum Oval, hard mass, initially suspected genital tract tumor, the patient subsequently leaked urine, further examination of vaginal foreign body, genital incision surgery, take out a plastic cap of a mist deodorant, repair leaks, and The suprapubic bladder catheter was placed. There was still leakage of urine after operation. The venous pyelography showed right hydronephrosis. The cystoscopy showed that the bladder vaginal fistula and the right ureter were unclear. Further, the bladder and venous rouge test was performed with milk. Transurethral vaginal fistula, laparoscopic ureteral bladder anastomosis, stent placement in the bladder, cured 2 months later.
(2) Fecal sputum: is a rare complication. Large rectal vaginal fistula can directly see the pupil under the exposure of the vaginal speculum. The pupil with very small pupil often sees a bright red granule on the posterior wall of the vagina. Tissue, probe from here, while using another finger into the vagina, can directly contact the probe to confirm the diagnosis, small intestine or colon vagina need to be diagnosed by barium enema.
2. Translocation into adjacent organs: Entering the bladder can form bladder stones; or penetrate the vaginal canal into the pelvic cavity, forming pelvic foreign bodies, broad ligament foreign bodies, etc., Pan Xuezhen reports a case of 21-year-old patient, 10 years ago, unknown reasons for a perfume bottle Covered into the vagina at the time, feeling vulva and vaginal acupuncture-like pain, no vaginal bleeding, no severe abdominal pain, because of shame in the teeth did not seek medical treatment, after which there is often a pale yellow odor liquid discharge, sexual intercourse in the vagina foreign body sensation, with sexual intercourse pain Has repeatedly taken foreign bodies unsuccessful, gynecological examination: vaginal patency, see a lot of purulent secretions, smelly, vaginal mucosa rough, thickening, granular scar tissue formation, cervical lower lip defect, hard, right side A hard mass of 4cm × 5cm can be placed next to it. The boundary is unclear, the activity is poor, and there is no obvious tenderness. The X-ray of the pelvis shows: pelvic foreign body, and the laparotomy under continuous epidural anesthesia is seen. The ligament is a rigid mass. After the capsule is cut, the pus is discharged. A 2cm×2cm cylindrical metal perfume bottle cap is taken out of the abscess and treated for 12 days.
3. Pelvic infection: Abscess formation of long-term vaginal foreign body in addition to causing chronic inflammation of the vagina such as vaginitis, vulvitis, cervicitis; urinary tract inflammation such as cystitis, urethritis, but also cause connective tissue hyperplasia formation, etc., due to sexual life The external force can cause foreign bodies to penetrate the vagina and move into the pelvic cavity and even the broad ligament, forming a pelvic abscess and a broad ligament abscess; in severe cases, the infection spreads, causing pelvic peritonitis, septic shock and sepsis.
4. Vaginal adhesion: partial vaginal atresia caused by local inflammation of granulation tissue, scar formation, severely affected by menstrual blood exclusion, irregular vaginal bleeding or long-term pus and bloody secretions, due to poor menstrual discharge caused by amenorrhea, with periodic lower abdominal pain Or continuous lower abdomen pain, upper vaginal atresia can shorten the vagina, painful intercourse or difficulty in sexual intercourse.
5. Cervical scar: For the long-term existence of vaginal foreign body, the formation of vaginal vault and cervical scar tissue can affect the opening of the cervix and the decline of the first exposure of the cervix, leading to obstructive dystocia in the soft canal, such as excessive uterine contraction. Can cause uterine rupture, this situation is safer to choose to end the delivery of cesarean section.
6. Toxic shock syndrome (TSS): Toxic shock syndrome is caused by improper use of menstrual plugs. The sign was first reported in 1978 and appeared in women aged 12 to 24 years old. Superabsorbent menstrual plugs are linked. Most cases occur in California, Minnesota, Wisconsin, etc. The peak incidence was in August 1980, and the incidence rate dropped sharply. The annual incidence rate of women in menstruation is 6/100,000~ 7/100,000, toxic shock syndrome also occurs in the following cases: after delivery and in women with diaphragm, after surgery or in men or women with soft tissue abscess or osteomyelitis, the incidence of non-menstrual diseases in the past 10 There was only a slight increase during the year.
Symptom
Symptoms of vaginal foreign body Common symptoms Pain in the lumbosacral ache, vaginal palsy, tenderness, vaginal discharge, increased urgency, secondary infection, sexual intercourse, pain, vaginal, a small amount of bleeding, severe pain, urinary fistula
Symptom
(1) Pain and bleeding: Large foreign bodies, irritating foreign objects such as folk "sitting medicine" can cause severe pain and bleeding in the vagina, or glass, perfume bottles, etc., when trying to take out, rupture, damage the vaginal wall, there are also The patient presented with chronic chronic pelvic pain or lumbosacral pain. A 75-year-old patient was hospitalized for paraplegia. The patient complained of white odor and pelvic pain for 25 years. Double and triple examination It was found that there was a spherical object in the vagina, and the granular granulation tissue around it was proliferated, about 3 to 4 cm from the vaginal opening. The diameter of the spherical object was about 4 cm when the pelvic X-ray was examined. The vaginal spherical object may be removed under the general anesthesia. It was placed 25 years ago to treat pelvic tissue loss.
(2) increased vaginal secretions with odor: according to the nature of foreign bodies, can cause acute, chronic vaginitis, manifested as vaginal itching, increased vaginal secretions, with odor; or a large number of pus, bloody secretions; or repeated The onset of pale yellow, thin, astringent liquid discharge, due to long-term stimulation of secretions or leakage of urine due to complications, may be combined with vulvitis, manifested as rash on the inside of the genital and even the thigh, secondary infection, genital burning pain ,Can not move.
The vaginal foreign body of the young girl has no pain at the time or short time of the occurrence, or usually tells the mother about vaginal itching, does not attract attention, or dares not tell the parents because of fear, and is discovered by the parents when the vaginal discharge increases or hemorrhage Attention, therefore, the young girl who encounters vaginal discharge in the outpatient clinic, the medical history is vague, the possibility of foreign body should be thought of, especially the treatment that has not been improved according to inflammation, should pay more attention, can not fully believe the history of vaginal foreign body denied by the patient And sloppy diagnosis and treatment.
(3) vaginal foreign body sensation with sexual intercourse pain: women with a history of sexual life may have foreign body sensation during sexual intercourse due to the size of foreign body, severe sexual intercourse pain, long-term foreign body retention caused by scar formation, vaginal atresia, or even sexual intercourse, Lesy reports A 21-year-old woman complained of painful sexual intercourse and vaginal discharge for five years, her vaginal vault formed a scar adhesion, and a 3.2cm × 2.2cm plastic bottle cap in the depth of the scar.
(4) dysuria, urgency: vaginal foreign body compression bladder or bladder stones, urinary pain, urgency symptoms.
(5) When vaginal foreign body causes complications such as urinary fistula or fecal fistula, clinical leakage may occur, and feces may be discharged through the vagina or paroxysmal exhaustion in the vagina.
2. Signs
(1) Gynecological examination showed that the skin mucosa around the vulva and vaginal opening was congested, flushed, and partially eczema-like.
(2) vaginal speculum examination can detect foreign bodies, infants and young children have vaginal foreign bodies, such as foreign bodies larger and harder, can be found in the examination of the anus examination, but soft and small foreign bodies, difficult to detect, need under general anesthesia Penetrate the vaginal examination with a nose.
(3) See the vaginal wall flushing, congestion, and even ulcer formation, the typical ulcer is located in the vaginal forasia, round, irregular edges, red particles at the bottom, the new epithelium of the ulcer edge can fall off.
(4) The formation of vaginal vagina and rectal vaginal fistula, pupils can be seen on the vaginal wall, urine and feces in the vagina, individual patients with small pupils or hidden parts, need to be diagnosed by auxiliary examination.
(5) Long-term chronic inflammation causes vaginal mucosal granulation to proliferate and form polyps; when inflammation is further developed and accompanied by infection, vaginal stenosis, adhesion, and even partial vaginal atresia may occur.
(6) When there is foreign matter, there are often mixed bacteria in the vagina, such as Haemophilus vaginalis, Neisseria gonorrhoeae, Chlamydia, Mycoplasma, Ureaplasma urealyticum, Trichomonas, etc., which can be diagnosed by staining or culturing with secretions.
Examine
Vaginal foreign body inspection
1. Vaginal secretion smear: Find trichomoniasis, Candida and other pathogenic microorganisms to determine the type of infection, vaginal foreign body is easy to be infected, vaginal secretion smear examination is helpful for diagnosis and treatment.
2. Vaginal exfoliative cytology: assist in the diagnosis of inflammatory reactions, exclude malignant tumors, such as infants and young children should exclude grape sarcoma of the cervix and vagina.
3. Methylene blue test: The purpose is to identify vaginal fistula, cervicovaginal fistula or ureterovaginal fistula, and can help identify very small pupils of unknown location by injecting 200ml of diluted methylene blue solution into the bladder through the urethra. To the blue liquid through the small hole in the vaginal wall, the bladder is vaginal fistula; the blue liquid through the external cervix is the bladder cervix; the clear blood in the vagina, indicating that the urine is from the kidney, is a ureterovaginal fistula.
4. X-ray film inspection: Depending on the nature of the foreign body, opaque shadows are sometimes visible.
5. Cystoscopy: Can understand the condition of the bladder, whether there are stones, inflammation, especially the location and number of leaks.
6. vaginal lavage: often used for young girls or girls, vaginal lavage can not only improve the vaginal environment, is conducive to the treatment of vaginitis, while small foreign bodies can also be washed out of the vagina, to confirm the diagnosis, from the University of Michigan pediatrics and adolescent gynecology The clinical report reviewed 31 cases of abnormal vaginal discharge before puberty from 1996 to 2000, with an average age of 6 years, and vaginal discharge for 13 months (1 to 42 months). Among them, 15 cases were excluded from vaginal foreign bodies, accounting for 52 cases. %, 7 cases of vaginal lavage were found in 2 cases of vaginal foreign body, 10 cases of colposcopic examination showed no abnormalities, the author believes that vaginal lavage can be used as a routine method to exclude young girls vaginal foreign body.
7. Intravenous pyelography: intravenous injection of 76% diatrizoate, at 5, 15, 30, 45min, to understand bilateral renal function and ureter abnormalities, for the diagnosis of ureterovaginal fistula.
Diagnosis
Diagnosis of vaginal foreign body
Basis for diagnosis:
1. A history of foreign body stuffing into the vagina, or a history of suspected vaginal foreign bodies.
2. The clinical manifestation is an increase in vaginal secretions, which is purulent, watery, with odor.
3. Anal finger examination can detect foreign bodies in the vagina, and women with sexual life history can make a diagnosis by vaginal examination.
4. If necessary, make B-ultrasound, X-ray, CT and other auxiliary inspections.
5. Generally no signs or symptoms of systemic infection.
6. Local inflammation of the genital tract can be confirmed by secretion smear, culture or PCR.
7. Children with some small and soft non-metallic foreign bodies are more difficult to diagnose. Foreign children have a colposcopy to confirm the diagnosis. There is no special instrument for vaginal examination in children.
Differential diagnosis
1. Vaginitis: Increased secretion of vaginal foreign body, should be distinguished from bacterial, trichomonas and candida vaginitis, trichomonas vaginal discharge is yellow foam, candida is like bean curd, and the main symptoms are vulva Itching, through the speculum examination and vaginal secretion examination, can help diagnosis, infants and young children can be used for anal examination, no vaginal foreign body.
2. Cervicitis: The main manifestation is also increased vaginal secretions, which should be differentiated from vaginal foreign bodies. This disease is often accompanied by genital itching, bladder irritation, cervical congestion and edema at the time of examination, purulent mucus on the surface, no vaginal foreign body.
3. Vaginal mites infection: more common in young women, accompanied by severe itching, genital skin, especially around the anus can appear dermatitis and scratches, vaginal smear inflammation is light, transparent adhesive paper anal test can be found in the eggs.
4. Reproductive system malignant tumors: When vaginal secretions are stench, they should be differentiated from malignant tumors, such as cervical cancer, endometrial cancer, vaginal cancer, fallopian tube cancer, ovarian cancer, etc., through vaginal speculum examination, vaginal exfoliation cell examination And biopsy can be diagnosed.
Asrtid Novak reported that a 73-year-old man accidentally put an olive oil bottle into the vagina. When he tried to take it out, the bottle was broken and he went to the hospital. The doctor took the debris and further examined it and found that the patient had urinary retention of about 1200ml. A large cystic mass can be accessed in the attachment area, which is a surgical exploration and is confirmed as a borderline ovarian tumor.
