Should Hysteroscopy Be More Preferably Employed for Treating Vaginal Foreign Bodies in Preadolescent Girls?

Background: Vaginal foreign body (VFB) is an uncommon but clinically important condition in preadolescent gynecology. Timely diagnosis and removal of VFB are essential to prevent complications such as infection, ulceration, and long-term reproductive sequelae. While the use of hysteroscope for vaginoscopy is considered the diagnostic gold standard and enables the surgical removal of the VFB, ultrasound remains more widely used due to its non-invasive nature, low cost and convenience. However, the application of hysteroscopy in the diagnosis and treatment of VFBs in China remains relatively limited due to cultural and socioeconomic factors, as well as anesthesia-related risks. Methods: This retrospective study included 67 pediatric patients with clinically suspected or hysteroscopically confirmed VFBs treated at Chengdu Women’s and Children’s Central Hospital from January 2011 to February 2025. Clinical data were collected, including patient age, symptoms, symptom duration, type of foreign body, pathological findings, hospitalization duration. The diagnostic performance of transabdominal and transperineal ultrasound was compared, using hysteroscopy as the reference gold standard. Results: Among the 67 cases, the most common symptoms were vaginal discharge and bleeding. Textile fibers, hair, and small toys were the most frequently identified VFBs. Transabdominal ultrasound demonstrated a sensitivity, specificity, and accuracy of 58.3%, 41.2%, and 53.8%, respectively. Transperineal ultrasound showed improved sensitivity (75.0%) and accuracy (63.1%) but similarly limited specificity (29.4%). Hysteroscopy facilitates both diagnosis and direct removal of VFBs while avoiding injuring the hymen. Despite its advantages, barriers to hysteroscopy included the need for anesthesia and hospitalization, which may affect parental acceptance. Conclusion: Ultrasound, although commonly used, exhibits poor diagnostic performance in detecting VFB in preadolescent girls. Hysteroscopy, with its superior accuracy and therapeutic capability, should be more preferably considered as diagnostic and treatment modality.