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with Jane Harrison-Hohner, RN, RNP and Laura Corio, MD

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Monday, May 21, 2012

Oh No, Where Did It Go? When Things Get “Lost” In the Vagina

By Jane Harrison-Hohner, RN, RNP

Surprised Woman

While the vagina is actually a structure with side and back walls, women can get panic stricken when an item seems to get lost or is not retrievable. We get requests on our Community Board for help in getting things back out of the vagina. Similarly, as a clinician I would sometimes find “lost” objects during a speculum exaam.

Lost Condoms

According to some studies, 28-33% of condom users have reported breakage, slippage, or both. According to one study of 834 condom-protected sex acts, 7% involved slippage with sex and 8% had slippage during withdrawal. Either breakage or slippage could result in all or part of a condom being left inside the vagina.

Should this happen to you, a first concern might be to obtain the morning after pill (also known as emergency contraceptive pills [ECP]) if one wishes to avoid an unplanned pregnancy. Depending upon the specific type of ECP, you can use the medication up to 72 hours after the condom accident. Some types of ECPs are most effective if taken right away. For a brief overview of where to get an ECP and how to take it, you can check out my blog on this topic.

To get the remains of a condom out of the vagina you can try one of several methods. The quickest is to have your partner insert two clean fingers (index and middle finger work best) into the vagina and use a gentle sweeping motion from the back walls of the vagina toward the front. They might feel your cervix (feels firm like the end of one’s nose) at the end of the vaginal canal. If they do feel the cervix they should gently sweep their fingers around the cervix to be sure the condom is not pushed up against the back of the vaginal wall. If you do not ask for your partner’s help, you can do this same technique half sitting with your back up against a firm surface (e.g., headboard of bed).  If you have short fingers, or a longer vaginal canal, you can put one foot up on the toilet or tub, insert the two clean fingers, and bear down like you are trying to have a bowel movement. This will bring the cervix and back wall of the vagina down so you can reach farther up inside. Certainly you could choose to see your GYN or local family planning clinic and have them remove the condom.

Lost Tampons

As one MD stated in an article about unusual causes of vaginal discharge, “seek and you shall find” applies to retained tampons and other foreign objects. In my experience the most common explanation for a retained tampon was a forgotten tampon that was then pushed even further back by inserting a second tampon. I have also removed small tampons that were inserted at the end of menstruation for less messy sex. After intercourse the tampon, and more importantly the string for removal, were pushed to the back wall of the vagina.

To remove a retained tampon one can try any of the three methods described above. If a tampon is accidentally left in place for several weeks it can change vaginal pH. This will encourage overgrowth of the anaerobic bacteria responsible for bacterial vaginosis (“BV”), a well-known cause of bad-smelling vaginal discharge. Once the tampon is detected and removed, if the smell like dead tuna fish does not resolve, antibiotics can be prescribed to eliminate BV organisms.

A question that frequently arises is, “What about the risk for Toxic Shock Syndrome with a lost tampon?” Beginning in the 1980’s Toxic Shock Syndrome (TSS) was reported with increasing frequency in menstruating women using tampons. Its symptoms included a fever of greater than 102 degrees, vomiting/diarrhea, low blood pressure, and a sunburn-like rash on the palms of the hand which later peeled like a sunburn. TSS, both menstrual and that associated with pneumonia and skin infections, is caused by a super-antigen-producing strain of one of our normal skin bacteria (Staph aureus). Like many skin bacteria, Staph aureus can be found in the vaginas of between 10-30% of healthy women. But far fewer women will test positive for the super-antigen producing subtype. This might explain why only 70-100 cases of TSS (both menstrual and nonmenstrual) are reported in the USA per year. Thus, the relatively low numbers of women having the TSS-producing subtype of staph bacteria may be the reason why every retained tampon is not an immediate time bomb for TSS.

Foreign Objects

Unlike condoms and tampons, which are designed for vaginal use, other objects can be inserted in the vaginal canal. Objects reported in the medical literature to have been found in vaginas include: aerosol deodorant cap, the plastic top to a can of hair spray, and a hard plastic stopper. I have personally found a plastic ring with spikes, designed to fit around the base of a penis, in a woman’s vagina. She stated that she did not know how it got in there. So readers, do not fear to see a GYN if a sex toy part needs to be fished out; a GYN will have already seen or heard it all.

Removal of foreign objects, especially if large, should be left to a GYN. If needed, removal can involve day surgery or anesthesia. If a foreign object is left in place it is likely to create a malodorous vaginal discharge. It can also place pressure on delicate tissues, creating an ulceration or fistula (open channel between the vagina and bladder or rectum). This kind of tissue damage tends to be the result of long misplaced objects.

In conclusion, many women (especially condom and tampon users) can expect to have difficulty removing an object from the vagina at some point in their lives. Try to stay relaxed, use the techniques discussed above, and above all know that there is no other place for the object to go.

Photo: Polka Dot

Posted by: Jane Harrison-Hohner, RN, RNP at 6:27 am

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