An unexpected source of acute onset rectal pain

An embarrassed teenager obscures the truth until a healthcare provider identifies the source of pain upon exam.

An unexpected source of acute onset rectal pain
An unexpected source of acute onset rectal pain

One of my patients called our office, and insisted on making an appointment for her 14-year-old daughter for evaluation of a rectal tear. Our triage nurse encouraged her to seek care with a surgeon if there was really a rectal tear, but the mother insisted that she trusted only me with her daughter's care. Reluctantly, our nurse scheduled the girl with me.

On interviewing the girl, she stated that she had an acute onset of rectal pain while standing around in class on a Monday afternoon. She insisted that the pain came on suddenly and without warning. She stated that it was unbearable pain, and that she had gone home from school, because of her severe discomfort.

The patient's mother interjected at that point, and told me that the girl's father had taken her to a local urgent care center for evaluation two days prior. The mother did not go along for the visit, because she was unable to leave her workplace. The mother stated the urgent care provider had told the girl's father it was probably a rectal tear, but the provider had just talked to the patient and had not performed a physical exam or evaluation.

At that point I asked the mother to leave the room, so I could talk with the patient. She insisted that there had been no rectal trauma, and denied sexual activity, molestation or rape. I had her get undressed, and lie on her left side. The anus was intact, with no signs of trauma. I inserted a glove into the rectum, and felt a hard object, but not in the rectum -- there was something hard in the vagina.

I had the girl turn back over, at which point I asked, "What's in your vagina?"

"The cap from a hair spray can," she whispered and started crying. "It hurts so bad. I've tried to get it out, but I can't!"

My mind started racing trying to figure out how to remove the object. I was worried about causing more trauma since she was a virgin. It finally dawned on me that if she put this object in there, she has "room" for it. Therefore, I should be able to remove it.

I gently place the blades of a very well lubricated Graves speculum above and below the object. Sure enough it was the cap from a hair spray can, with its sharp edges pointing towards the vaginal introitus and away from the cervix. Using long surgical scissors, I carefully cut a wedge out of the cap on either side, allowing the cap to partially collapse. I was then able to carefully removed it.

The girl was nearly hysterical with relief! She agreed that I could tell her mother, who was initially upset, but then amused and very relieved. I discussed sexual issues with the patient and encouraged her to find safe ways to satisfy her sexual urges. I also strongly urged both the patient to always tell the whole truth to any provider, so that a problem can be solved easily, safely and quickly.

This teen was so embarrassed about her situation, that she kept the truth from everyone, including me, until I discovered it upon her exam. Had she told the whole story to her mother, I would have been contacted first and would have solved her problem in one visit. Her visit to the urgent care clinic was a total waste of time and money and certainly did not solve her problem.

The patient and her mother left the clinic happy and satisfied. Hopefully this episode will serve to open more communication between the two of them regarding sexual issues.


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