Retained Tampon

Casebank History
1

Pt came with greenish discharge at GP.
Foul smelling. LMP 3 - 4 weeks ago. Symptoms started 3 weeks ago.-
Stable sexual partner. husband had vasectomy. No safe sex
Discharge greenish in colour with tinge of blood for 2 months - using of tampoon - foul smell - no change of sexual partner - feeling awkward due to smell and has hard time teaching in class - no cancer symptoms - on per speculum examination inflamed cervix which is red

DD: Causes of vaginal discharge ( infective PID (tummy pain and fever) + Sexual Hx STI ( positive UPSI ) Vaginosis or Candida ( colour … appearance…bathes or douches )
2- non infective Inadequate hygiene ( Hx of no frequent change of tampons or pads )
Retained FB ( Hx like tampos )
Menopause ( age )
Cancer ( flaws )
Fistula ( Hx of surgery… Crohn’s… delivery )
Allergic vagintis ( use soap or tampons )
Behcet ( other dry eye …Oro genital ulcers)

Request for urine dipstick
Speculum examination

Tampons should not be placed for more than 8 hours

Tx - removal to tampon using forceps - offer procedure - take high endocervical swabs as well - antibiotics are not usually required but we will consider antibiotics considering the long duration nature of retained tampons. - safety net - referral to gynaecologist urgently if retrieval fails

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2

(Retained tampon) - Non infective cause of vaginal discharge

  • comes with greenish discharge at GP. Foul smelling. LMP 3 - 4 weeks ago. Symptoms started 3 weeks ago. (>8 hrs now)
  • Stable sexual partner. husband had vasectomy. No safe sex

Mx

  • removal to tampon using forceps - offer procedure
  • take high endocervical swabs as well
  • antibiotics are not usually required but we will consider antibiotics considering the long duration nature of retained tampons.
  • safety net - referral to gynaecologist urgently if retrieval fails
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3

Vaginal discharge d2 Retained Tampon
station of vaginal discharge:

Prompt

  • comes with greenish discharge at GP. Foul smelling. LMP 3 - 4 weeks ago.
    Symptoms started 3 weeks ago. (>8 hrs now)
  • Stable sexual partner. husband had vasectomy. No safe sex

Background

  • greenish in colour with tinge of blood for 2 months
  • using of tampoon
  • foul smell
  • no change of sexual partner
  • feeling awkward due to smell and has hard time teaching in class
  • no cancer symptoms
  • on per speculum examination inflamed cervix which is red

DD’s
Causes of vaginal discharge

  1. Infective
  • PID (tummy pain and fever) + Sexual Hx
  • STI ( positive UPSI )
  • Vaginosis or Candida (colour, appearance, bathes or douches )
  1. Non infective
  • Inadequate hygiene ( Hx of no frequent change of tampons or pads )
  • Retained FB ( Hx like tampos )
  • Menopause ( age )
  • Cancer ( flaws )
  • Fistula ( Hx of surgery… Crohn’s… delivery )
  • Allergic vagintis ( use soap or tampons )
  • Behcet ( other dry eye …Oro genital ulcers)

ADDITIONAL TIPS

  1. Tampons ideally not be for more than 8 hours in its place
    Since how long it is there ?
    positiyclu
  2. Pregnancy test if child bearing period
    Urine test (Dipstick)
    With speculum EX.
    3- IF Infection on top of retained FB
    We will need to remove it and take trial for this if failed will consider referral for
    specialist or GUM to remove it

TTT

  • removal to tampon using forceps - offer procedure
  • take high endocervical swabs as well
  • antibiotics are not usually required but we will consider antibiotics considering
    the long duration nature of retained tampons.
  • safety net - referral to gynaecologist urgently if retrieval fails
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4

SAILORS’ APPROACH TO RETAINED TAMPON

Where are you
You are an FY2 in GP

Who is your patient
Mary Muller aged 29 years, has come with some concerns.

Other information about the patient
None

What you should do
Talk to him and address her concerns

PATIENT INFORMATION
Opening statement: Doctor, I have been experiencing abnormal vaginal discharge
You have had the discharge for 2weeks now. Discharge is greenish and foul smelling, no tummy pain, itching or fever. No dysuria or urgency.
You are Married with 2 children, nil hx of STI
You live with your partner and kids
You have no other sexual partners and You are worried about the possibility of your partner cheating on you, because where else could you have gotten this from?
You recently started using tampons for menstrual bleeds.
When the candidate examines you and tells you he saw a tampon in the vagina, tell him you had no idea you left a tampon there.
You have a healthy lifestyle.

Examiner’s prompt:
Observations- normal
Speculum- Greenish discharge with tampon found in the vagina

Concerns:
What is wrong with me?
What caused this?
Is my husband cheating on me?

APPROACH
GRIPS
How may I help you?
Dr i have an abnormal vaginal discharge.
FODPARA of discharge
On the discharge:
Onset
Duration
Color
Odor
Volume

DD:
PID: tummy pain, fever
UTI: dysuria, frequency
Risk factors for vaginal discharge
-bubble bathing
-douching

Sexual hx:
Sexually active
Stable partner
Partner male/female
Route of sex
Use of condom
Previous STI
Previous STI in partner

Menstrual and contraceptive hx
PMAFTOSA
ICE
JARSS

Examine : Greenish discharge with tampon found in the vagina

As soon as you are done with the examination and have explained your findings to the patient, you need to ask Follow up questions about the tampon.
When did you put it?
How long its been there
Is this the first time using tampon?
How long does she normally remove the tampon after use?
Did you have sex after inserting the tampons?

Ass:
From my assessment, you have a retained tampon. This may likely led to a vaginal infection which is causing this foul smelling greenish discharge. To really know what bug might be responsible, we need to remove the tampons using a speculum and take both tampon and swab for culture.

MANAGEMENT

  • Give antibiotics according to hospital protocol to prevent the spread of this infection which although rare, may be potentially life-threatening (toxic shock syndrome)

  • Is my husband cheating on me?
    You seem to be quite worried about your husband cheating on you. Right now we are not quite sure but we found a tampon in your front passage which could be a source of this infection. How about you have a discussion with your husband regarding this when you get home?

Advice

  • Tampon usage: remove after 8hrs of insertion and if stuck pls locate your nearest Gp for removal
  • Complications of prolonged stuck tampons: Toxic shock syndrome (fever, hypotension, rash, weakness and sometimes organfailure
  • STI screening

Safety Net (toxic shock syndrome)
-features of Tummy pain, fever, hypotension etc

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5

what is JARSS , please ?

6

Jobs Activities Relationship Sex Sleep

7

RETAINED TAMPON

Where are you
You are an FY2 in GP

Who is your patient
Mary Muller aged 29 years, has come with some concerns.

Other information about the patient
None

What you should do
Talk to him and address her concerns

PATIENT INFORMATION
Opening statement: Doctor, I have been experiencing abnormal vaginal discharge
You have had the discharge for 2weeks now. Discharge is greenish and foul smelling, no tummy pain, itching or fever. No dysuria or urgency.
You are Married with 2 children, nil hx of STI
You live with your partner and kids
You have no other sexual partners and You are worried about the possibility of your partner cheating on you, because where else could you have gotten this from?
You recently started using tampons for menstrual bleeds.
When the candidate examines you and tells you he saw a tampon in the vagina, tell him you had no idea you left a tampon there.
You have a healthy lifestyle.

Examiner’s prompt:
Observations- normal
Speculum- Greenish discharge with tampon found in the vagina

Concerns:
What is wrong with me?
What caused this?
Is my husband cheating on me?

APPROACH
GRIPS
How may I help you?
Dr i have an abnormal vaginal discharge.
FODPARA of discharge
On the discharge:
Onset
Duration
Color
Odor
Volume

DD:
PID: tummy pain, fever
UTI: dysuria, frequency
Risk factors for vaginal discharge
-bubble bathing
-douching

Sexual hx:
Sexually active
Stable partner
Partner male/female
Route of sex
Use of condom
Previous STI
Previous STI in partner

Menstrual and contraceptive hx
PMAFTOSA
ICE
JARSS

Examine : Speculum exam…Greenish discharge with tampon found in the vagina

As soon as you are done with the examination and have explained your findings to the patient, you need to ask Follow up questions about the tampon.

*When did you put it?
*How long its been there
*Is this the first time using tampon?
*How long does she normally remove the tampon after use?
?Did you have sex after inserting the tampons?

DIAGNOSIS
From my assessment, you have a retained tampon. This may likely have led to a vaginal infection which is causing this foul smelling greenish discharge. To really know what bug might be responsible, we need to remove the tampons using a speculum and take both tampon and swab for culture.

*Swab and Tampon culture

MANAGEMENT

*Investigation…routine and inflammatory markers, urine dipstick

*STI screening

*Give antibiotics according to hospital protocol to prevent the spread of this infection which although rare, may be potentially life-threatening (toxic shock syndrome-TSS)

GENERAL ADVICE
*Tampon usage:
Remove after 8hrs of insertion and if stuck pls locate your nearest Gp for removal

  • Complications of prolonged stuck tampons:
    Toxic shock syndrome
    fever
    hypotension
    rash
    weakness
    organ failure

ADDRESS CONCERNS

  • Is my husband cheating on me?

You seem to be quite worried about your husband cheating on you. Right now we are not quite sure but we found a tampon in your front passage which could be a source of this infection. How about you have a discussion with your husband regarding this when you get home?

Inform seniors

Leaflets

Safety Net (toxic shock syndrome)
-features of Tummy pain, fever, hypotension etc

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