What is the treatment for a retained vaginal tampon (intrauterine device) in a female patient?

From the Guidelines

A retained tampon should be promptly removed to prevent complications like toxic shock syndrome. If a patient suspects a retained tampon, they should seek medical attention where a healthcare provider can perform a vaginal examination and safely remove the tampon using forceps or their fingers. After removal, the vagina should be examined for any remaining pieces. Patients may need antibiotics if there are signs of infection such as fever, unusual discharge, or pelvic pain. Following removal, patients should monitor for symptoms like fever, rash, or increasing pain which could indicate toxic shock syndrome, a rare but serious complication. To prevent future occurrences, patients should track tampon use, change tampons every 4-8 hours, and consider using lower absorbency tampons or alternative menstrual products. Retained tampons can cause bacterial overgrowth, particularly Staphylococcus aureus, which produces toxins that can enter the bloodstream and cause systemic symptoms if left untreated. The provided evidence 1 does not directly address the treatment of retained tampons, but it emphasizes the importance of prompt treatment and management of infections, such as PID, to prevent complications.

Key Considerations

• Prompt removal of the retained tampon is crucial to prevent complications
• Patients should seek medical attention if they suspect a retained tampon
• Antibiotics may be necessary if there are signs of infection
• Patients should monitor for symptoms of toxic shock syndrome after removal
• Preventive measures, such as tracking tampon use and changing tampons regularly, can help prevent future occurrences

Management

The management of a retained tampon involves prompt removal and examination of the vagina for any remaining pieces. Patients should be counseled on the importance of tracking tampon use and changing tampons regularly to prevent future occurrences. If there are signs of infection, antibiotics should be prescribed, and patients should be monitored for symptoms of toxic shock syndrome. The provided evidence 1 highlights the importance of prompt treatment and management of infections to prevent complications, although it does not directly address the treatment of retained tampons.

From the Research

Treatment of Retained Tampon in Female

• The primary concern with a retained tampon is the risk of toxic shock syndrome (TSS), a potentially life-threatening condition 2, 3, 4.
• TSS is caused by bacterial superantigenic exotoxins, which can lead to rapid shock, multiple organ failure syndrome, and death 4.
• In cases of retained tampon, it is essential to remove the tampon and initiate treatment promptly to prevent the development of TSS.
• Treatment of TSS typically involves:
  • Immediate resuscitation
  • Source control and eradication of toxin production
  • Bactericidal antibiotic treatment
  • Protein synthesis inhibiting antibiotic administration 4, 5
• Antibiotics such as beta-lactam and lincosamides, like clindamycin, are commonly used to treat TSS 5.
• In some cases, additional treatments like rifampicin may be used to treat recurrent TSS 3.
• It is crucial to note that TSS can occur even after discontinuation of tampon use, and women should be advised to seek medical attention immediately if they experience symptoms of TSS 3.