Vaginal foreign bodies and child sexual abuse

Objective: To determine whether vaginal foreign bodies (VFBs) in prepubertal girls are associated with sexual abuse and whether evidence exists in earlier reports for such an association. Design: Retrospective case review. Setting: General pediatric clinic at Duke University Medical Center, Durham, NC. Participants: All 12 girls 10 years of age and under who, between 1985 and 1988, were seen in the general clinic and subsequently found to have VFBs. Interventions: None. Measurements and Results: Clinic protocol required referral of all children with vaginal bleeding, unusual discharge, or VFBs to the Child Protection Team at the medical center, which also served as a pediatric gynecology consultation service. Records for the 12 girls, whose mean age was 6.3 years, showed 19 visits for single, multiple, or recurrent VFBs. Two girls had concurrent sexually transmitted diseases. Eight met diagnostic criteria for confirmed sexual abuse; three, for suspected abuse, and in one, abuse status was unknown. Conclusions: Vaginal foreign bodies in young girls may be a previously unrecognized indicator of sexual abuse. Girls with VFBs should be evaluated for possible sexual abuse. Prospective studies on the suggested association between VFBs and sexual abuse need to be conducted. (Arch Pediatr Adolesc Med. 1994;148:195-200)
Pre-teenage girls who are diagnosed with vaginal foreign bodies (VFB) may be victims of sexual abuse. Researchers reviewed medical records of 12 girls under age 11 who were diagnosed with a total of 28 VFBs. Most patients sought medical care for vaginal discharge, spotting or bleeding, or odor. Nearly half of the girls experienced more than one occurrence of VFBs. All patients had vaginal discharge and two girls were diagnosed with a sexually transmitted disease. Four girls had other vaginal infections. Genital abnormalities were observed in nine patients. Examination of the foreign bodies after removal revealed material including tissue paper, adult body hair, cotton balls, a plastic cap, and unidentifiable matter. Sexual abuse was confirmed in eight of eleven patients and suspected in two others. Eight victims identified their abuser, although no girl explained how the VFB was acquired.