VAGINITIS III—CHEMICAL, TRAUMATIC
Some vaginal inﬂammations, in addition to those due to direct bacterial invasion, are caused by the ill-advised introduction of foreign objects or substances. Vaginal douches and solutions have been used for a variety of gynecologic conditions, and an incalculable number of proprietary douche powders or ﬂuids have been devised to alleviate or cure different types of real or perceived disturbances. Although it is doubtful that the brief contact of the vaginal epithelium with the materials contained in a commercial douche produces a salutary effect other than a cleansing one, the practice continues to be widespread. When homemade solutions or other agents are used, the risk is increased. The danger of such a procedure is the possibility of producing a chemical burn, with marked redness, swelling, and ulceration of the vaginal walls. Under these circumstances, a purulent exudate soon appears, and the patient suffers from intense local pain. Such accidents were particularly perilous when, during early pregnancy, various solutions were used to induce abortion. Even with the availability of elective pregnancy terminations, cases of this nature are still encountered. If the immediate damage has not been too severe, the inﬂammation may subside spontaneously or with mild palliative therapy, but if a necrotizing drug has been applied, adhesions may form that scar or occlude the vagina and cause dyspareunia.
Foreign bodies in the vagina can also lead to infection and ulceration of the vaginal epithelium, whereas the symptoms may be referred to the bladder or rectum. Pins, coins, marbles, and many other objects have been recovered from the vaginas of children or those temporarily or permanently impaired. The insertion of these articles may be the result of attempted masturbation or abuse. The purulent discharge that eventually results brings the child and her mother to the clinic. A history of the sudden onset of profuse leukorrhea in an infant or child should alert the physician to the possibility of a foreign body in the vagina, and a hysteroscope or cystoscope may be valuable for obtaining the exposure necessary to examine the vagina and remove the offending object. If it is embedded in the vaginal wall because of long neglect, removal may be difﬁcult, but the inﬂammatory process quickly subsides once its cause has been eliminated.
On occasion, one may ﬁnd very ordinary everyday objects inserted into the vagina, but more often the retention of a foreign body is explained by neglect of a situation originally established for a speciﬁc therapeutic purpose. Tampons inserted to control menstrual ﬂow and forgotten may be responsible for inﬂammation and leukorrhea. When tampons are used toward the end of menstrual ﬂow or the patient is in the habit of infrequent tampon changes, there is a greater risk that the tampon will be forgotten, leading to irritation and secondary bacterial infection.
Pessaries are designed to correct displacements of uterus, bladder, or rectum, but if they become neglected, infection or other damage may result. This is particularly true if the patient has a poor memory or for those who may be remiss in their personal hygiene. Hard rubber or metal ring pessaries used for uterine prolapse are especially likely to give trouble, because if not regularly taken out and cleaned, with simultaneous inspection of the vagina, they give rise to severe local infection, cystitis, and pyometra, or they may even become embedded deep in the vaginal wall. Gross hemorrhage also may occasionally occur. Removal of foreign bodies is usually a simple ofﬁce procedure, but in an exceptional case general anesthesia and an operating room setup may be required. To avoid these complications, follow up of pessary users should occur at regular intervals.