Persistent Blood-Tinged Discharge After Retained Tampon
You need a pelvic examination to rule out retained tampon fragments and assess for vaginal trauma or infection. One week of persistent blood-tinged discharge after a 4-day retained tampon warrants direct visualization to exclude complications that cannot be diagnosed by history alone.
Immediate Evaluation Required
A speculum examination is essential because:
- Retained tampon fragments can persist even when the patient believes the tampon was fully removed, and these fragments can cause ongoing discharge, odor, and risk of infection 1
- In cases of retained foreign bodies like tampons, vaginoscopy may be critical for diagnosis when initial examination appears negative 1
- Blood-tinged discharge persisting one week after removal suggests either retained material, vaginal mucosal trauma, or secondary infection 1
What to Look For During Examination
The examining clinician should specifically assess for:
- Retained tampon fragments in the vaginal fornices or adherent to vaginal walls, which may not be immediately visible 1, 2
- Vaginal wall lacerations or erosions from prolonged tampon contact 1
- Signs of infection including purulent discharge, erythema, or friable mucosa 1
- Cervical involvement to exclude cervicitis or other pathology 3
Risk Stratification by Symptoms
While you have blood-tinged discharge, assess for these concerning features:
- Lower abdominal pain or dyspareunia would mandate pelvic examination to exclude pelvic inflammatory disease, which requires bimanual assessment 3
- Fever, foul odor, or systemic symptoms raise concern for ascending infection requiring urgent evaluation 3
- Your isolated blood-tinged discharge without pain still requires speculum examination but is less concerning for upper tract involvement 3
Why Examination Cannot Be Deferred
- Adolescents and young women presenting with tampon loss have an 80% rate of finding retained material on examination, making thorough visualization mandatory 2
- Retained foreign bodies can cause vesicovaginal fistula and other serious complications if left undiagnosed, though this typically requires longer retention periods 1
- Non-invasive testing cannot exclude retained fragments or assess mucosal integrity 4
Expected Management
If retained material is found:
- Complete removal of all debris using vaginoscopy if needed 1
- No routine antibiotics are indicated unless signs of infection are present 1
- Follow-up in 1-2 weeks to confirm resolution of symptoms 1
If no retained material is found:
- Reassurance that blood-tinged discharge may persist for several days as vaginal mucosa heals from irritation
- Return if discharge worsens, develops odor, or if pain develops 3
Common Pitfall to Avoid
Do not assume the tampon was completely removed based on patient history alone. Even when patients report successful removal, fragments can remain adherent to vaginal walls and require direct visualization for diagnosis 1, 2. The atypical presentation of persistent discharge one week later makes examination even more critical to exclude complications 1.