Retained foreign objects can lead to purulent and malodorous vaginal discharge in females. The most common retained foreign object in prepubertal girls is toilet paper, whereas in postpubertal adolescents, it is a retained tampon. However, other foreign objects such as sticks, coins, and safety pins have been described. It is often difficult to elicit a history of a retained object.

A vaginal foreign object can lead to secondary infection. Failure to resolve and/or unresponsiveness and recurrence after appropriate treatment, based on a positive culture of vaginal discharge, should raise suspicion for a retained foreign object. Since a vaginal exam is often difficult in a child, a foreign object may not be ruled out until an appropriate exam is completed under anesthesia. Placing the child in a knee-chest position facilitates the examination and visualization of a vaginal foreign object in a prepubescent girl. In addition, a rectal exam may reveal a foreign object via palpation.

Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign anogenital skin conditions.