Retained tampon or vaginal foreign body in girls

A retained foreign body is any object that has been placed in the vagina and left there. Children's Health explains that a foreign body can lead to increased discharge, tissue injury, infection and bleeding. The object is not dangerous because it travels anywhere. It causes trouble because it irritates the lining and gives bacteria a place to grow.

The NHS page on periods states that it is not possible for a tampon to get lost inside you. A tampon cannot pass through the cervix into the womb or elsewhere. What can happen is that it is forgotten, or that the string is hard to find, and it stays in the vagina longer than intended.

Children's Health says that in young children the objects have often been inserted by the child out of curiosity, in the same way that foreign objects are found in the ear or nose. Toilet paper can also become trapped. In menstruating adolescents, a tampon may be forgotten, and in sexually active young women a contraceptive device may be left in.

The same source adds, calmly, that in rare cases a foreign body may be linked to sexual abuse, so clinicians ask questions with the wider picture in mind. If a young person has been hurt or is frightened, they should be heard and protected, and any concerns can be raised with a GP, school safeguarding lead or NHS 111. Most cases are not connected with abuse.

Children's Health lists bleeding, especially in a child who is not menstruating, foul-smelling or copious vaginal discharge, pain in the lower abdomen, urinary discomfort and a burning sensation. A doctor may then check for a foreign body.

The NHS explains that normal discharge is clear or white, does not smell strongly and is thick and sticky or slippery and wet. A change in smell, colour or texture, more discharge than usual, itching or soreness, bleeding between periods and pain on peeing are reasons to call NHS 111 or see a GP. Smell alone does not identify the cause, so do not self-diagnose.

• Persistent smelly or heavy discharge that does not settle.

• Spotting or bleeding at times that do not fit a period, or in a girl who has not started periods.

• Lower tummy pain, or pain or burning when passing urine.

• A teenager who remembers a tampon that she cannot now find or feel.

Most retained tampons cause local problems, but one rare complication is serious. The NHS describes toxic shock syndrome (TSS) as a rare but life-threatening condition caused by an infection that can happen when using a tampon or menstrual cup, or from an infected wound. Symptoms develop quickly and need urgent treatment.

The NHS lists a high temperature or feeling hot, cold or shivery, muscle aches, a rash that feels rough like sandpaper, vomiting and diarrhoea, bright red palms, soles, tongue or whites of the eyes, swollen or peeling skin, and feeling sick, dizzy or confused. It says to get help from NHS 111 and, if you are using a tampon or cup, to remove it and tell 111 you were using one.

Call 999 or go to A&E for confusion, slurred speech, blue, grey, pale or blotchy skin, a rash that does not fade under a glass, difficulty breathing, or large areas of peeling skin. For babies and young children, the NHS adds a weak high-pitched cry and being unusually sleepy or difficult to wake.

Children's Health says the doctor first examines the child and asks about symptoms, and may take a vaginal swab and urine culture to test for bacterial infection. If toilet paper is suspected, the vagina may be flushed with saline while the child is in the clinic, to help it come out.

In some cases an examination under anaesthetic in an operating room is used to find and remove the object. This is more likely in younger children who cannot tolerate an examination or where the object is out of reach. In a teenager who knows she used a tampon, the doctor may be able to find and remove it during an examination.

Children's Health states that a foreign body must be removed to prevent further irritation and infection. The doctor may remove it in the office if it is accessible, or use a narrow, lighted endoscope while the child is asleep in an operating room. Antibiotics may be prescribed if infection is suspected, and the tissue should heal on its own.

After removal, ask the clinician what to expect and when to return, and seek follow-up if bleeding or discharge continues. Menstruating teenagers should be reminded to change tampons regularly, as Children's Health advises.

The NHS TSS page advises washing hands and following the instructions when using tampons, menstrual cups, contraceptive caps and diaphragms, and not leaving them in longer than needed or recommended. If a person has had TSS before, a doctor may advise against tampons.

For young children, calm, matter-of-fact explanations about what stays outside the body help. For teenagers, the NHS notes that if a tampon is inserted correctly you should not be able to feel it, and that tampons come with instructions and a string for removal. Using a reminder to change it, and switching to pads overnight, are practical habits.

Embarrassment delays care. A teenager who is worried she has left one in can be reassured that clinicians deal with this routinely and that early removal avoids complications. If she has symptoms of TSS, treat it as an emergency rather than waiting.