title: Vaginal foreign body: a delayed diagnosis.
abstract: BACKGROUND
  To describe a case of prolonged vaginal bleeding in a prepubertal girl. Review of medical record and literature search.
  
  
  METHODS
  A 7-year-old female was referred to our pediatric and adolescent gynecologic clinic for evaluation of vaginal bleeding and ovarian cyst on ultrasonography. Her parents denied any history of trauma or sexual abuse. Initial evaluation revealed pre-pubertal luteinizing hormone and follicle stimulating hormone levels, and follow-up ultrasonography revealed normal pre-pubertal pelvic anatomy. However, a skeletal survey, which was obtained to assess for the presence of skeletal fibrous dysplasia, revealed a metal spring in the vagina. The patient ultimately underwent an exam under anesthesia and vaginoscopy with removal of 3 foreign bodies, with subsequent termination of symptoms.
  
  
  CONCLUSIONS
  In cases of pre-pubertal vaginal bleeding, the possibility of vaginal foreign body should not be excluded despite normal sonographic imaging. If clinical suspicion for a vaginal foreign body persists, additional imaging modalities or exam under anesthesia should be considered.
authors.affiliation: Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: nayaksr2@upmc.edu.
authors.forename: Shweta
authors.initials: S
authors.lastname: Nayak
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Selma Feldman
authors.initials: SF
authors.lastname: Witchel
authors.affiliation: Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Sanfilippo
mesh_terms: D002648:Child; D057210:Delayed Diagnosis; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D058869:Gynecological Examination; D006801:Humans; D008670:Metals; D011859:Radiography; D014592:Uterine Hemorrhage / Q000209:etiology*; D014621:Vagina / Q000293:injuries*
chemical_list: D008670:Metals
keywords: Foreign Body; Premenarchal; Vaginal bleeding