context: Some objects are designed for use in a woman's vagina. These include tampons, vaginal suppositories, diaphrams, and medications delivered through the vagina. Others are not intended to be inserted and may be placed there accidentally or intentionally. Doctors refer to objects found in the vagina as "foreign bodies." These foreign bodies may produce symptoms or be asymptomatic for long periods of time. Small objects inserted into the vagina do not generally cause pain. Unusual objects, generally those larger than the customary vaginal diameter, may cause pain because of distention. Other objects may cause pain due to sharp edges. While a variety of symptoms may result from a foreign body in the vagina, the most common symptoms are bleeding or foul-smelling vaginal discharge. Less common symptoms may include pain or urinary discomfort. Perforation through the vagina into the abdominal cavity may also result in acute abdominal symptoms. Systemic infection can occur, but rarely. The most common foreign body of the vagina in small children is small amounts of fibrous material from clothing and carpets, or most often, toilet paper. They may also place objects in their vagina at a time of self-exploration. The objects may be forgotten, or once placed in the vagina, unable to be removed by the child. Other common objects include marker caps or crayons. The objects found in children generally are small and do not cause pain from distention. Children will generally not place objects larger than the vaginal entrance due to discomfort. Adolescent women may use tampons once their period begins. Occasionally, these tampons are forgotten and may not be removed for days. The breakage of a condom may also result in bits of latex or non-latex material being left in the vagina. Adults may place foreign objects into the vagina as part of a sexual experience. Less commonly unusual objects may be placed in the vagina as the result of abuse. Adults may also experience forgotten tampons or bits of a condom. While small objects placed in the vagina may remain for a period of time without symptoms, larger objects may produce pain or discomfort immediately. See a doctor. Common symptoms of a vaginal foreign body include the following: Vaginal discharge, generally foul-smelling and yellow, pink, or brown Vaginal bleeding, especially light bleeding Vaginal itching or foul odor Discomfort with urination Discomfort due to vaginal discharge producing skin irritation Abdominal or pelvic pain from placement of large objects or perforation of a foreign body into the abdominal cavity Skin redness Swelling of the vagina and its entrance Rash in the vaginal area The presence of a vaginal foreign body may alter the normal bacterial flora of the vagina, resulting in repeated efforts to treat "vaginitis." The symptoms of a vaginal discharge may be interpreted as vaginitis, a sexually transmitted infection or even a yeast infection. Repeated use of antibiotics or other medications will not remove the symptoms if a foreign body remains present. Objects left in the vagina very rarely lead to serious complications. However, the medical literature has had several case reports of pelvic abscess and subsequent scarring. A health care provider should be consulted when any change in vaginal discharge is present, particularly discharge which is foul-smelling or abnormal in color. The presence of a foreign body may cause abnormal vaginal bleeding. If a foreign object was placed in the vagina and may still be there, the health care provider should be informed. Occasionally, an adult or adolescent woman may remember placing a tampon, but then be unable to remove it from the vagina. Unusual objects may need to be removed using sedation or anesthesia in order to avoid pain. This may be particularly true of objects placed in the vagina of a small child or an adult who is unable to be cooperative with a vaginal exam. Some emergency departments allow sedation and removal in the emergency department without going to an operating room. Vaginal foreign bodies are seen more commonly in children than in adolescent or adult women. Children may not be able to supply the history of an object placed in the vagina; however, some children will say that they have lost an object in their vagina. In addition to obtaining specific information about a possible vaginal foreign body, a health care provider will perform a general history and physical exam as well. It is appropriate for the health care provider to ask about questions related to sexual activity and sexual or physical abuse. Methods for diagnosing and retrieving foreign bodies depend on the age of the female patient and sometimes the duration of time the object has been in the vagina. For young girls, any visit to a doctor's office can be frightening. If a foreign object is suspected in a young girl, the physician may gently examine the vulva and vaginal entrance by separating the labia and glimpsing the foreign object. This may allow removal in the office through such techniques as warm water flushing of the vagina, but other larger objects may require sedation or examination under anesthesia for removal. An adolescent patient may easily have a foreign body removed from the vagina in the outpatient setting. This may also hold true for adults. Visualization of the foreign body using a speculum and removal with a forceps may be the most efficient treatment. Unusual objects or those that may disrupt the vaginal wall may require sedation or anesthesia for removal, and to complete a thorough exam of the vagina and cervix. If an object has been present in the vagina for a long time, that object may cause erosion into the wall of the vagina. Recent placement of an unusual object in the vagina may cause perforation of the vaginal wall and secondary symptoms of an intra-abdominal infection. Although examination generally reveals the presence of a foreign body, some imaging techniques may also be helpful. These may include a CT (computerized tomography) scan or an abdominal X-ray. Ultrasonography may also assist in the location of a foreign body in the vagina or pelvis. Bacterial infections or alteration in the normal bacterial flora of the vagina may be due to the presence of a foreign body altering the usual environment of the vagina. Removal may be performed with the forceps or with a warm water irrigation of the vagina. Once the foreign object is moved, antibiotics are generally not needed. Teenagers and older women may generally have foreign bodies removed in the outpatient setting; however, those patients who are unable to cooperate for an exam may also benefit from sedation or removal in the operating room. Larger objects and those causing pain after placement in the vagina may require anesthesia for complete removal and inspection of the vaginal walls. These more complex procedures may require antibiotics. Larger objects and objects causing painful infections will require anesthesia for pain and relaxation of vaginal muscles. Objects that have moved from the vagina to the abdomen or to other parts of the body will require surgery for removal. Once the object is removed and antibiotics are given, infection, fever, pain, and vaginal discharge should soon clear up. If symptoms of vaginal discharge, bleeding, abnormal odor, or urinary tract symptoms continue after an object has been removed, a repeat evaluation by a health care provider is recommended. If symptoms resolve once a foreign body is removed, follow-up may not be necessary. Repeat examination may be recommended if the health care provider is not certain the entire object has been removed or if any complexities, such as secondary infection is diagnosed at the time of removal of the foreign body. Prevention of infections related to foreign objects in the vagina begins with good vulvovaginal hygiene. In young children, parents should instruct perineal cleaning by wiping front to back. This will decrease the amount of bacteria and feces that may enter the vagina. Poor perineal hygiene may cause irritation of the vulva or vagina. Parents can also aid in the prevention of foreign bodies of the vagina by talking with children about their bodies and teaching them the proper names of their body parts, such as vagina, urethra, anus, and rectum. Knowing the correct names of body parts will allow children to better communicate any problems. For example, children may be able to describe these body parts to adults in instances of pain, discharge, or possible abuse. For older girls and women, good hygiene includes limiting the amount of time objects remain in the vagina. Tampons should be used no longer than six to eight hours. Sexual activities resulting in painful placement of objects in the vagina should be avoided. Medications for vaginal infections or irritation should be used only when prescribed by a health care provider. Patients may commonly misdiagnose the reasons behind vaginal discharge. Douches or vaginal washes are not needed to clean the vagina. Douching may increase the risk of infection due to washing away the normal bacteria which help to fight infection. Showers and baths are satisfactory for cleaning the vaginal area.