Hysteroscopy Is A Promising Diagnostic and Therapeutic Approach for Vaginal Foreign Bodies in Preadolescent Girls

BACKGROUND: Vaginal foreign bodies (VFBs) are rare yet clinically significant in preadolescent gynecology. Prompt identification and removal are crucial to avert complications such as infection, mucosal injury or ulceration, and potential long-term reproductive consequences. Although hysteroscopic vaginoscopy is widely regarded as the reference standard and allows simultaneous extraction, ultrasound is more commonly used because it is noninvasive, inexpensive, and readily accessible. In China, however, hysteroscopy for VFBs is underutilized due to cultural and socioeconomic considerations and concerns related to anesthesia. METHODS: We conducted a retrospective review of 73 girls with suspected or hysteroscopically confirmed VFBs managed at Chengdu Women's and Children's Central Hospital or Yunyang County People's Hospital between January 2011 and February 2025. Extracted variables included age, presenting symptoms and duration, foreign-body type, pathology results, and length of stay. Diagnostic performance of transabdominal and transperineal ultrasound was evaluated with hysteroscopy as the comparator. RESULTS: Vaginal discharge and bleeding were the leading clinical presentations (34/73, 46.6%; 27/73, 37.0%, respectively). Commonly retrieved objects included textile fibers (20/73, 27.4%) and plastic tubes or fragments (5/73, 6.8%). Transabdominal ultrasound showed sensitivity, specificity, and overall accuracy of 0.556, 0.412, and 0.521, respectively. Transperineal ultrasound yielded higher sensitivity (0.704) and accuracy (0.606) but remained limited in specificity (0.294). CONCLUSION: Ultrasound demonstrated suboptimal diagnostic performance for VFBs in preadolescent girls. Given its greater diagnostic yield and therapeutic utility, hysteroscopy should be considered earlier as a preferred diagnostic and treatment option, especially in cases with negative ultrasound findings of foreign body but persistent clinical symptoms.