Beyond the obvious: A rare case of more than 70 complex vaginal foreign body insertion presenting with urinary incontinence.

Khinkar A1, Bamanie E1, Dendeni M1, Bin Obaid W1, Abdullah A1

Research Type

Clinical

Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 819
Non Discussion ePosters - Case Reports
Scientific Non Discussion Poster Session 300
Incontinence Overactive Bladder Female
1. King Abdulaziz Medical City
Links

Abstract

Hypothesis / aims of study
Vaginal foreign bodies (VFBs) frequently occur in pediatric and teenage females, posing diagnostic difficulties for healthcare professionals(1). A comprehensive study of 522 instances revealed an average patient age of 6 years and 3 months, with vaginal bleeding and discharge identified as the predominant symptoms (2). Atypical manifestations may arise, including recurring urinary tract infections (3)Pediatric patients often ingest toys, tissue paper, and household items, whereas adults may retain tampons, condoms, or sexual devices(2,4). Toilet paper was recognized as the most prevalent foreign object (2). Here we present a rare case of unusual insertion of more than seventy objects into the vagina over the course of 4 years, presenting with urinary incontinence
Study design, materials and methods
Case report
Results
A 28-year-old single lady, known case of corpus callosum dysgenesis, with a latest IQ score of 61. She was referred to our urogynecology clinic due to foul-smelling vaginal discharge and urge urinary incontinence. She presented to the outpatient clinic after she had been treated with multiple courses of antibiotics for recurrent urinary tract infection and vaginitis. The patient had been complaining of urge incontinence and persistent foul-smelling discharge for the past 4 years. Physical examination of the patient revealed poor hygiene, a foul-smelling brownish discharge, and no vulvar skin changes noted. Vaginal digital examination was not performed as the patient was a virgin. Per rectal examination, the anterior wall of the rectum was pushed in with a hard mass, which might be vaginal in origin. Genital culture taken, which demonstrated normal vaginal flora. A pelvic radiograph displayed a radio-opaque object, most likely a battery, in the vagina or upper rectum. Computed tomography was done with findings of multiple dense foreign bodies in the vagina, with no gross extension beyond the vaginal vault. The patient was informed about the findings, and then she admitted to inserting the battery 5 years ago, which the mother supported, saying that her daughter's symptoms started around that time. She underwent examination under anesthesia. Intraoperatively, after positioning the patient, the patient's gown was soiled with urine and stool. Cystoscopy was done; the urethra and urinary bladder were intact; no fistula or foreign body was identified. Gently, a right-angled retractor was placed on the posterior wall of the vagina. The vagina was clogged with multiple small foreign bodies that were adherent to each other, forming one mass filling the vagina (Fig. 1). A total of 64 pieces of cotton Q-tip, 17 pieces of marble balls, one piece of AA battery, and one pencil were removed in pieces (Fig. 2). Irrigation with povidone-iodine solution was done. The vaginal wall was noted to be thickened, otherwise normal with no ulcers or injuries. The cervix looked normal, and a Pap smear was obtained. The Pap smear was negative for dysplasia and malignancy. Subsequent rectal examination showed an intact rectum. The postoperative course was uneventful, and she was discharged the following day. After 4 weeks, the patient was seen in the clinic. She had no complaints and denied any urinary symptoms or discharge. She was referred to mental health to perform a psychiatric evaluation to diagnose or address any underlying psychiatric condition.
Interpretation of results
--
Concluding message
This case highlights the diagnostic challenges and clinical repercussions of abnormal vaginal foreign body insertion, particularly when presenting with atypical symptoms such as urinary incontinence. A high index of suspicion through detailed history taking and meticulous pelvic examination is essential to avoid missed and delayed diagnosis. 

A multidisciplinary approach involving psychiatric services is vital for comprehensive management.
Figure 1
Figure 2
References
  1. Lehembre-Shiah E, Gomez-Lobo V. Vaginal Foreign Bodies in the Pediatric and Adolescent Age Group: A Review of Current Literature and Discussion of Best Practices in Diagnosis and Management. J Pediatr Adolesc Gynecol. 2024 Apr;37(2):121–5.
  2. Umans E, Boogaerts M, Vergauwe B, Verest A, Van Calenbergh S. Vaginal foreign body in the pediatric patient: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:153–8.
  3. Neulander EZ, Tiktinsky A, Romanowsky I, Kaneti J. Urinary Tract Infection as a Single Presenting Sign of Multiple Vaginal Foreign Bodies: Case Report and Review of the Literature. J Pediatr Adolesc Gynecol. 2010 Feb 1;23(1):e31–3
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee King Abdullah International Medical Research Center Helsinki Yes Informed Consent Yes
16/07/2025 15:13:11