The Case of the Vanishing Yoni Pearl

Abstract

Case: A 41-year-old female presented to the Emergency Department (ED) with a retained vaginal foreign body (VFB). She reported inserting a detoxifying “yoni” pearl 36 hours prior. She was unable to remove it herself. She denied fever, vaginal pain, discharge, or dysuria. A gynecologist was consulted, and the VFB was removed manually without complications. Conclusions: The authors reviewed 29 case studies and series. Overall, tampons, condoms, menstrual cups, items used for sexual gratification, and unconventional items used for barrier contraception (e.g., aerosol caps) are among the most common VFBs in premenopausal adult women. Among postmenopausal adult women, medical devices such as pessaries can be neglected in the vagina leading to retained VFB. While most cases had no contributing risk factors, associated medical and social determinants include mental health disorders, history of sexual assault, and uninsured status. This is the first documented case of a detoxifying vaginal pearl VFB. Clinical Significance: VFB is a common presentation in the United States; from 2010 to 2014, 89,160 female patients presented to the ED with a vulvar/vaginal foreign body, many requiring gynecologic or urologic consultations and invasive procedures. Although this case was without complications, VFBs can have significant morbidity. Depending on the consistency of the foreign body, VFBs can serve as a nidus for infection with subsequent sepsis, most notably toxic shock syndrome. Other serious complications of VFBs are compression of tissue, which can lead to compromise of blood flow to that region, necrosis, perforation, and fistulas (i.e., rectovaginal or vesicovaginal). Fistula formation has also been reported as a direct result of the surgical trauma from removal of the VFB. Prevention efforts should be aimed at education about what can safely be placed in the vagina, and providers should focus on dispelling misinformation surrounding vaginal detoxification and cleanliness.