Vaginal Foreign Bodies and Child Sexual Abuse: An Important Consideration
A 6-year-old girl presented to the PED with a chief complaint of a green vaginal discharge for 6 days. The girl’s father reported that 6 days prior to the evaluation, the child complained of pain and itching in the vaginal area and developed a yellowish-brown vaginal discharge. Over the course of the week, the discharge had changed in color from yellowish-brown to green but had no odor. When directly questioned by her father and the EP, the girl denied any inappropriate touching.\nHer physical examination in the PED was noteworthy for vulvar erythema and a copious, milky, yellow-green discharge. In addition, a whitish foreign body, which appeared to be a wad of toilet tissue, was visualized and extracted from the vagina. Cultures of the vaginal discharge were obtained, and the child was discharged from the PED with instructions to follow up with her pediatrician if the discharge persisted.\nFour days later the PED was notified that the culture of the vaginal discharge was positive for N. gonorrhea. The family was contacted and the child was referred to the SARA Center at the UMMC for further evaluation and treatment. Further history revealed persistence of the vaginal discharge, which was now more yellow in color, and the child was treated with Ceftriaxone. The case was then referred to the local CAC for further evaluation of sexual abuse.