The glamour

Case 6

Ms MT, age 21

• profuse extremely offensive vaginal discharge, intercourse restricted and uncomfortable
• O/E very offensive discharge, may be able to see whitish mass in vagina

Diagnosis: Retained vaginal tampon

Aetiology: Theoretically the tampon could become impacted, but in my experience the patient forgets it is there. Maybe it gets up into the posterior fornix, and the patient continues to insert and remove other tampons for the duration of the period, ignorant of its presence.

Significant features: It is the odour that drives them to the doctor. This case suggests difficulties with intercourse. My patients have not had intercourse because the odour is too embarrassing.

Treatment: If you are not careful, you will fill the consulting room with a disgusting stench, and you have to get rid of that before you see the next patient. So as soon as you realise what the problem is, you get a container of water, and pull the tampon out with sponge holders and submerge it in one quick movement, then dispose of it appropriately; or you pull it out with a gloved hand, turn the glove inside out immediately, and dispose it quickly. If you handle the situation tactfully, assure them that it has happened to other people, and that all is now well, they will be extremely grateful. Tactless facial expressions and they may be too embarrassed to ever come back.

Hah!