Vaginal Foreign Bodies

　　一、发病原因

　　1、阴道异物的来源：

　　（1）异物由他人塞入：如手术或治疗时遗留的棉球及纱布等；为增强性刺激，由性伙伴将玻璃杯、杜松子酒瓶、饮料瓶、金属珠宝盒等塞入阴道。

　　（2）自行塞入：常见于婴幼儿出于好奇心或企图解除阴道瘙痒等，将异物塞入阴道。丁淑珍报道的9例婴幼儿阴道异物，年龄3～10周岁，均智力正常，其中由年龄相仿的儿童塞入阴道者3例；由精神失常的成人塞入阴道2例；自己塞入2例；不明原因2例。

　　2、阴道异物分类：误入幼女阴道内的异物种类颇多，常见的有：发卡、火柴棍、花生米、玉米粒、黄豆、麦粒、自行车滚珠、香烟过滤嘴、小石头、塑料笔帽、麻秆、别针、小母子扣、短塑料绳、玻璃安瓿、金属香水瓶盖等。成人有为寻求性刺激自己将黄瓜、橘子、洋葱、香水瓶、阳物模具等塞入阴道，最终无法取出，或由于疏忽将避孕用具遗忘在阴道内。

　　二、发病机制

　　1、塞入异物用于治疗目的如阴道手术后遗留的纱布，用于压迫或止血；阴道内放置子宫托治疗子宫脱垂的病人，长时间未取出时，导致阴道菌群的变化和急性炎症反应。

　　2、用于避孕的阴道异物将避孕套、阴道隔膜、宫颈帽等遗留于阴道内。

　　3、用于堕胎或引产民间的“坐药”可对阴道黏膜产生腐蚀作用，有的未婚先孕的女孩自行堕胎，将各种异物放入阴道。

　　4、性刺激由性伙伴或自行将各种异物塞入阴道，在酒醉时较易发生，多见于生育年龄妇女也有发生于老年妇女。AsrtidNovak报告3例老年妇女的阴道异物，其中一位为81岁，因阴道疼痛急诊来院，从其阴道内取出一个塑料制阴茎样异物，她自己承认每周用该物手淫1～2次；另一例69岁妇女阴道内有一玻璃酒杯，7年前丈夫由于无法性交而用酒杯替代，事后该夫妇未能将其取出，而其丈夫禁止她求医，直到丈夫去世后她才来就医，切开后无法将玻璃杯完整取出，只能将碎片逐一取出。

　　5、异物由其他部位侵入到生殖道。

　　最常见的并发症有：

　　1、阴道瘘长期：存在阴道内的固体异物会压迫局部组织，致缺血坏死，甚至侵入膀胱或直肠，形成阴道瘘，包括尿瘘和粪瘘，致使尿液或粪便经阴道排出。

　　2. Displacement into adjacent organs:Entering the bladder can form bladder stones; or penetrating the vaginal fornix into the pelvis, forming pelvic foreign bodies and broad ligament foreign bodies, etc. Pan Xuezhen reported a case of a 21-year-old patient who, 10 years ago, inserted a perfume bottle cap into her vagina and felt a piercing pain in the vulva and vagina. There was no vaginal bleeding and no severe abdominal pain. She did not seek medical attention due to shame. Since then, she has often had a light yellow, smelly discharge. During sexual intercourse, she felt a foreign body in the vagina, accompanied by pain during sexual intercourse. She has tried to remove the foreign body many times but failed. Gynecological examination: the vagina is patent, with a large amount of purulent discharge, smelling foul, with rough, thickened vaginal mucosa, showing granular scar tissue. The lower lip of the cervix is defective, hard, and a 4cm×5cm hard mass can be palpated on the right para-cervical area, with unclear boundaries, poor mobility, and no significant tenderness. Pelvic X-ray showed pelvic foreign bodies, and the patient underwent laparotomy under continuous epidural anesthesia. During the operation, a hard mass in the right broad ligament was seen, and after incising the capsule, pus was discharged. A 2cm×2cm cylindrical metal perfume bottle cap was removed from the pus cavity, and the patient was discharged after 12 days of treatment.

　　3. Pelvic infection:Long-term presence of vaginal foreign bodies can cause chronic inflammation such as vaginitis, vulvitis, and cervicitis; urinary tract inflammation such as cystitis and urethritis. In addition, it can cause the proliferation of connective tissue and the formation of polyps. Due to the external force during sexual intercourse, foreign bodies can penetrate the vagina and migrate to the pelvis, even to the broad ligament, forming pelvic abscesses and broad ligament abscesses. In severe cases, the infection can spread, causing pelvic peritonitis, infectious shock, and sepsis.

　　4. Vaginal adhesion:Partial vaginal atresia due to chronic inflammation can lead to local granulation tissue hyperplasia and scar formation. In severe cases, it can affect the expulsion of menstrual blood, resulting in irregular vaginal bleeding or long-term purulent discharge. Due to the poor expulsion of menstrual blood, amenorrhea may occur, accompanied by periodic lower abdominal pain or persistent lower abdominal ache. The atresia at the upper end of the vagina can shorten the vagina, causing pain or difficulty during sexual intercourse.

　　5. Cervical scar:For those with long-term presence of vaginal foreign bodies leading to the formation of scar tissue in the vaginal fornix and cervix, during labor, it can affect the dilation of the cervical os and the descent of the presenting part of the fetus, causing obstructive dystocia of the soft birth canal. If there is also strong uterine contraction, it can lead to uterine rupture. In such cases, it is safer to choose cesarean section to end labor.

　　6. Toxic shock syndrome:Toxic shock syndrome is caused by improper use of tampons. This syndrome was first reported in 1978, and it is more common in women aged 12 to 24 during their menstrual periods, thus being associated with the use of highly absorbent tampons. Most cases occurred in California, Minnesota, Wisconsin, and other states, with the peak incidence in August 1980. Since then, the incidence has decreased sharply, and currently, the annual incidence among menstruating women is 6 per 100,000 to 7 per 100,000. Toxic shock syndrome can also occur in the following situations: women after childbirth and those using diaphragms, as well as men and women with soft tissue abscesses or osteomyelitis after surgery. The incidence of non-menstrual diseases has only slightly increased in the past 10 years.

　　一、Symptoms

　　1. Pain and bleeding:Large foreign bodies or irritative foreign bodies such as folk 'sitting medicine' can cause severe pain and bleeding in the vagina, or glass cups, perfume bottles, etc. may break when trying to remove them, causing damage to the vaginal wall. Some patients may also present with long-term chronic pelvic pain or lower back and sacral pain. A 75-year-old patient with hemiplegia was hospitalized for treatment. The patient complained of foul vaginal discharge and pelvic pain for 25 years. Bimanual and three-hand examinations found a spherical object in the vagina, with granuloma-like tissue proliferation around it, about 3-4 cm from the vaginal orifice. Pelvic X-ray examination showed that the diameter of the spherical object was about 4 cm. The foreign body was removed under general anesthesia. The spherical object in the vagina may have been inserted 25 years ago for the treatment of pelvic organ relaxation.

　　2. Increased vaginal discharge with an odor:Depending on the nature of the foreign body, it can cause acute or chronic vaginitis, manifested as vaginal itching, increased vaginal discharge with an odor; or large amounts of purulent or bloody discharge; or recurrent discharge of pale yellow, thin, and fishy-smelling fluid. Due to long-term stimulation of the discharge or complications leading to urinary leakage, it may be accompanied by vulvitis, manifested as rashes on the vulva or even the inner side of the thigh, followed by secondary infection, leading to vulvar burning pain and difficulty in movement.

　　3. Vaginal foreign body sensation accompanied by sexual pain:Women with a sexual history may experience a sensation of foreign body during sexual intercourse due to the size of the foreign body, and severe pain during sexual intercourse. Long-term retention of the foreign body can lead to scar formation, vaginal atresia, and even inability to have sexual intercourse. Lesy reported a 21-year-old woman who complained of sexual pain and foul vaginal discharge for five years. The woman had scar adhesions in the vaginal fornix, with a 3.2cm×2.2cm plastic bottle cap in the scar depth.

　　4. Dysuria and urgency:Vaginal foreign bodies that compress the bladder or are accompanied by bladder calculi may cause symptoms such as dysuria and urgency.
、When vaginal foreign bodies cause complications such as urinary or fecal fistula, clinical symptoms such as urinary leakage, feces passing through the vagina, or intermittent vaginal排气 may occur.

　　二、Signs

　　1. Gynecological examination may show congestion and erythema of the skin and mucosa around the vulva and vaginal orifice, with some areas showing eczematous changes.

　　2. The examination with a vaginal speculum may reveal foreign bodies. In infants and young children, foreign bodies in the vagina can be found during rectal examination if they are large and hard. However, small and soft foreign bodies are not easy to detect and require inspection of the vagina with a nasal speculum under general anesthesia.

　　3. The vaginal wall may appear red, congested, and even ulcerated. The typical ulcer is located in the vaginal fornix, round with irregular edges, and has red granules at the bottom. The newly formed epithelium at the ulcer edge may fall off.

　　4. Patients with vesicovaginal or rectovaginal fistulae may show fistulae on the vaginal wall, with urine and fecal contamination inside the vagina. In some cases, the fistulae may be small or located in a concealed area, and auxiliary examinations are required for diagnosis.

　　5. Long-term chronic inflammation causes granulation tissue hyperplasia of the vaginal mucosa, forming polyps; further development of inflammation accompanied by infection can lead to vaginal stenosis, adhesions, and even partial closure of the vagina.

　　6. When there is a foreign body present, there are often mixed flora in the vagina, such as Haemophilus vaginalis, Neisseria gonorrhoeae, Chlamydia, Mycoplasma, Ureaplasma, Trichomonas, etc. Diagnosis can only be made through secretion smear staining or culture.

　　1. Vaginal foreign bodies are not uncommon in clinical practice. Vaginal foreign bodies can occur at any age, and are more common in young girls in China, and can also occur in adult patients with mental illness; normal adult women in foreign countries also occur occasionally.

　　2. For patients with symptoms such as vaginal bleeding, increased secretion, vaginal foreign body sensation, and urgency and pain during urination, especially young girls, it is necessary to carefully investigate the cause, actively treat, and prevent the occurrence of complications.

　　1. Vaginal secretion smear:Search for trichomonads, Candida, and other pathogenic microorganisms to determine the type of infection. Vaginal foreign bodies are prone to infection, and vaginal secretion smear examination is helpful for diagnosis and treatment.

　　2. Vaginal smear cytology examination:Assists in diagnosing inflammatory reactions and excluding malignant tumors, such as the exclusion of grape-like sarcoma of the cervix and vagina in infants and young children.

　　3. Methylene blue test:The purpose is to differentiate between vesicovaginal fistula, cervicovaginal fistula, or ureterovaginal fistula, and can assist in identifying extremely small fistulas with unclear locations. The method is to inject 200 ml of diluted methylene blue solution through the urethra into the bladder. If blue fluid is seen to ooze out through the small holes in the vaginal wall, it is a vesicovaginal fistula; if the blue fluid flows out through the external orifice of the cervix, it is a vesicocervical fistula; if clear urine flows out from the vagina, it indicates that the urine comes from the kidneys, which is a ureterovaginal fistula.

　　4. X-ray photography examination:According to the nature of the foreign body, it is sometimes possible to see opaque shadows.

　　5. Cystoscopy:Can understand the condition inside the bladder, whether there are stones, inflammation, especially the location and number of leak holes.

　　6. Vaginal lavage:Commonly used in young girls or adolescents, vaginal lavage not only improves the vaginal environment but is also conducive to the treatment of vaginitis. At the same time, small foreign bodies can also be flushed out of the vagina to clarify the diagnosis. A clinical report review from the Department of Pediatrics and Adolescent Gynecology at the University of Michigan summarized 31 cases of abnormal vaginal discharge before puberty from 1996 to 2000, with an average age of 6 years, and a duration of vaginal discharge of 13 months (1-42 months). Among them, 15 cases needed to be excluded for vaginal foreign bodies, accounting for 52%, 2 cases were found with vaginal foreign bodies in 7 cases of vaginal lavage, and 10 cases had no abnormalities found during colposcopy. The author believes that vaginal lavage can be used as a routine method to exclude vaginal foreign bodies in young girls.

　　7. Intravenous pyelography:After intravenous injection of 76% diatrizoate, films are taken at 5, 15, 30, and 45 minutes to understand the function of both kidneys and whether there are any abnormalities in the ureters, which is used for the diagnosis of vesicovaginal fistula.

　　What foods are good for the body when there is a vaginal foreign body

　　1. Supplement nutrition and enhance physical fitness, eat more milk, eggs, soy milk, lean meat, animal internal organs, etc.

　　2. Eat more foods with the effect of invigorating the spleen and removing dampness, such as yam, broad bean, lotus seed, white fungus, Job's tears, broad bean, mung bean, black fungus, cowpea, walnut kernel, light seafood, celery, turtle meat, pork stomach, black chicken, euryale, etc.

　　3. Yellowish blood-stained leukorrhea is due to damp-heat, so it is advisable to drink more soup and eat light foods, and eat more fresh vegetables: celery, chrysanthemum brain, winter melon, amaranth, watermelon, dandelion, mung bean, red bean, water chestnut, seaweed, portulaca, broad bean flower, mung bean, fungus, fresh lotus root, etc.

　　2. Foods to avoid in vaginal foreign bodies

　　1. Avoid fatty and sweet foods such as fatty meat, seafood, glutinous rice, and so on, to prevent dampness and phlegm.

　　2. Avoid fried and fried foods with dry heat.

　　3. Avoid刺激性食物 such as scallion, garlic, ginger, chili, and alcohol.

　　1. Western medicine treatment

　　1. Removal of foreign bodies:The methods for removing foreign bodies vary slightly depending on the age of the patient and the size, position, and shape of the foreign body.

　　(1) Vaginal extraction: Older children can push the foreign body out with their fingers or use a small speculum under direct vision to pick up the foreign body with forceps. Adults can directly pick up the foreign body under the direct vision of the speculum. Emge reported that a tangerine was successfully removed from the vagina using forceps: a tangerine. When removing sharp foreign bodies, the long axis of the foreign body should be parallel to the longitudinal axis of the vagina, with the sharp end facing the vaginal opening to prevent injury to the mucosal tissue.

　　(2) Anal retraction method: Young children can push the foreign body out by inserting a hemostat or small spatula into the vagina under the guidance of an anal examination finger.

　　(3) Nasal mirror: Expand the child's vagina with a nasal mirror, use forceps to pick up foreign bodies. If the child cannot cooperate, ketamine intravenous anesthesia can be used. The stem of the nasal mirror is about 3cm long and can reach the lower part of the vagina. Under the surface anesthesia of 1% tetracaine (dicaine), the vaginal opening is expanded with the nasal mirror, and then the foreign body is removed locally with a small spatula or retrieved with forceps. It is simple and convenient, does not cause injury, and is easy to popularize in primary-level hospitals.

　　(4) Removal of foreign bodies under hysteroscope: Due to the short length of the nasal mirror and the absence of a light source, it is sometimes difficult to achieve the purpose of diagnosis and treatment. There are reports of using hysteroscopy to remove foreign bodies from a young girl's vagina: local mucosal anesthesia is required during the operation, and a 1% tetracaine (dicaine) cotton ball is applied to the vaginal opening, followed by 5 minutes of inspection. Take the lithotomy position, routinely disinfect the perineum, and add 500ml of 5% glucose solution containing 160,000 units of gentamicin for perineal lavage. Apply lubricant to the hysteroscope and gently insert it into the vagina, then hold the cotton ball with the thumb and index finger of the left hand to compress the perineum, prevent the overflow of liquid, expand the vagina, and observe the pathological changes comprehensively under the direct vision of the hysteroscope. Necessary treatment should be given according to the condition, such as removing foreign bodies, taking living tissue for examination, lavage, and medication, etc.

　　(5) Microscopic vaginoscope: Parker reported in 2000 that a small diameter trocar sheath with a 2-3mm endoscope, using normal saline as the distension fluid, can visualize the entire cervix and vagina, find small foreign objects such as colored crayons, and can be treated under direct vision. It is used for the diagnosis and treatment of vaginal diseases in children before puberty, with simple operation, minimal injury, and easy acceptance.

　　(6) Vaginal irrigation: the catheter can be inserted into the vagina, and the vagina can be repeatedly irrigated under pressure with 40% achillea oil. Sometimes small foreign objects such as sand and wheat grains can be flushed out, and there is also an anti-inflammatory effect.

　　2. Local treatment:After the removal of foreign objects, routine treatment should be performed for vaginitis, using a 0.5% to 1% acetic acid solution for vaginal lavage, or a potassium permanganate solution at a concentration of 1/5000 for vaginal lavage, or 5% iodophor for vaginal wiping, or topical application of erythromycin ointment. For those suspected of having leeches burrowing into the vagina, there may be only hyperemia of the vaginal mucosa and small bleeding points, and topical application of erythromycin ointment and oral anti-inflammatory medication can be given. If it is inflammatory hemorrhage or if trichomonas is found in the laboratory, metronidazole (metronidazole) 0.2g should be dissolved and inserted into the vagina once a day for 7 days. For those with other specific vaginitis, treatment should be performed according to the corresponding treatment principles. A small number of polyps on the lateral wall of the vagina should be removed and pathological examination performed. If the pathological examination shows vaginal grape-like sarcoma, chemotherapy and radical surgery are required.

　　3. Vaginal repair surgeryAll patients with urinary fistula and anal fistula formation require surgical repair. The principles of surgical repair are:

　　(1) Generally, it should be waited for 3 to 6 months until inflammation subsides, scars soften, and local blood supply returns to normal before surgery.

　　(2) For those with bladder stones and inflammation, stone removal and repair should be performed after controlling the inflammation.

　　(3) For those with regular menstrual cycles, surgery should be performed 3 to 7 days after the menstrual period.

　　(4) Dexamethasone should be administered before surgery if necessary to promote scar softening.

　　(5) A bath with potassium permanganate solution at a concentration of 1/5000 should be taken 3 to 5 days before surgery, and those undergoing anal fistula repair should start a low-fiber diet 3 days before surgery and take norfloxacin or metronidazole orally to control intestinal bacteria.

　　(6) A catheter should be left in place for 7 to 14 days after the repair of a urinary fistula to ensure continuous and smooth bladder drainage and prevent urinary tract infection. After the repair of an anal fistula, opium alkaloids should be taken to control defecation for 4 to 5 days.

　　4. Vaginal adhesion separation surgeryLong-term placement of foreign bodies in the vagina can cause vaginal adhesions or partial vaginal atresia, which should be surgically separated. LeSQ reported a 21-year-old female who complained of dyspareunia and malodorous discharge for 5 years. For two years, she sought medical treatment for infertility. Examination revealed a tender mass in the posterior fornix of the vagina, granuloma proliferation in the middle segment of the vagina with a small hole at the top of the visible tissue discharging purulent secretion. Vaginal ultrasound confirmed a mixed mass of 5.4cm×5.0cm×5.1cm in the posterior fornix; a 2.8cm cup-shaped object surrounded by thick fluid and soft tissue. This confirmed that the abnormal vaginal fornix was formed by foreign bodies and granuloma proliferation surrounding them. The fistula was incised and dilated, with a large amount of malodorous secretion discharged, surrounding proliferative tissue separated, and the deeply embedded plastic bottle cap (3.2cm×2.2cm) removed. Excess scar tissue was excised to widen and deepen the vaginal apex. A vaginal model was placed postoperatively to prevent recurrence of adhesions. The patient had no memory of the foreign body's presence, and long-term granuloma proliferation surrounding it caused the upper end of the vagina to be atretic. The formation of the fistula made it look like the external os of the cervix, making the diagnosis difficult and requiring auxiliary examinations such as pelvic MRI.

　　5. LaparotomyMost complications caused by vaginal foreign bodies can be resolved through vaginal surgery, while a very few require laparotomy, such as pelvic abscess caused by vaginal foreign bodies, broad ligament abscess, vesicovaginal fistula, etc., or foreign bodies left in the vaginal apex after laparotomy. Hemelt reported a 70-year-old woman who underwent sacrocolpopexy through the abdomen due to vaginal prolapse and complained of chronic pelvic pain and a large amount of vaginal discharge postoperatively. Pelvic X-ray suggested a 'needle-like' substance at the vaginal incision, so a laparotomy was performed to remove the foreign body, which turned out to be a small piece of medical cotton swab left due to negligence. Binstock reported that the patient had a 4cm hard object in the vagina, which was removed under general anesthesia. It was the cap of an aerosol deodorant. Since the patient also had vesicovaginal fistula, bladder fistula, and rectovaginal fistula, a laparotomy was performed for ureterovesical anastomosis and bladder fistula repair, as well as vaginal wall repair through the vagina.

　　6. Enhanced supportive treatment is the key to successful rescue in the treatment of toxic shock syndrome:

　　(1) Treatment should begin with fluid and electrolyte replacement, and central venous pressure, pulmonary wedge pressure, and urine output should be monitored to guide treatment.

　　(2) Early laboratory tests and culture of pathogenic bacteria should be carried out.

　　(3) Dopamine can be used when blood pressure is low; naltrexone can correct hypotension by antagonizing the action of endorphins. If adult respiratory distress syndrome occurs, mechanical ventilation is required; if renal failure occurs, hemodialysis is needed.

　　(4) Early application of corticosteroids after diagnosis can reduce the harm of the disease and shorten the duration of fever.

　　(5) Although Staphylococcus aureus is not present in the blood circulation, it is still necessary to use beta-lactamase-resistant antibiotics such as nafcillin (ethoxycillin), oxacillin (oxacillin), or methicillin (methylpenicillin) for intravenous drip or intramuscular injection. If there is an allergy to penicillin, vancomycin 500mg can be used instead. The dose must be reduced if there is kidney injury.

　　Second, Western medical treatment methods for vaginal foreign bodies

　　1. Removal of foreign bodies:The methods for removing foreign bodies vary slightly depending on the age of the patient and the size, position, and shape of the foreign body.

　　(1) Vaginal extraction: Older children can push the foreign body out with their fingers or use a small speculum under direct vision to pick up the foreign body with forceps. Adults can directly pick up the foreign body under the direct vision of the speculum. Emge reported that a tangerine was successfully removed from the vagina using forceps: a tangerine. When removing sharp foreign bodies, the long axis of the foreign body should be parallel to the longitudinal axis of the vagina, with the sharp end facing the vaginal opening to prevent injury to the mucosal tissue.

　　(2) Anal retraction method: Young children can push the foreign body out by inserting a hemostat or small spatula into the vagina under the guidance of an anal examination finger.

　　(3) Nasal mirror: Expand the child's vagina with a nasal mirror, use forceps to pick up foreign bodies. If the child cannot cooperate, ketamine intravenous anesthesia can be used. The stem of the nasal mirror is about 3cm long and can reach the lower part of the vagina. Under the surface anesthesia of 1% tetracaine (dicaine), the vaginal opening is expanded with the nasal mirror, and then the foreign body is removed locally with a small spatula or retrieved with forceps. It is simple and convenient, does not cause injury, and is easy to popularize in primary-level hospitals.

　　(4) Removal of foreign bodies under hysteroscope: Due to the short length of the nasal mirror and the absence of a light source, it is sometimes difficult to achieve the purpose of diagnosis and treatment. There are reports of using hysteroscopy to remove foreign bodies from a young girl's vagina: local mucosal anesthesia is required during the operation, and a 1% tetracaine (dicaine) cotton ball is applied to the vaginal opening, followed by 5 minutes of inspection. Take the lithotomy position, routinely disinfect the perineum, and add 500ml of 5% glucose solution containing 160,000 units of gentamicin for perineal lavage. Apply lubricant to the hysteroscope and gently insert it into the vagina, then hold the cotton ball with the thumb and index finger of the left hand to compress the perineum, prevent the overflow of liquid, expand the vagina, and observe the pathological changes comprehensively under the direct vision of the hysteroscope. Necessary treatment should be given according to the condition, such as removing foreign bodies, taking living tissue for examination, lavage, and medication, etc.

　　(5) Microscopic vaginoscope: Parker reported in 2000 that a small diameter trocar sheath with a 2-3mm endoscope, using normal saline as the distension fluid, can visualize the entire cervix and vagina, find small foreign objects such as colored crayons, and can be treated under direct vision. It is used for the diagnosis and treatment of vaginal diseases in children before puberty, with simple operation, minimal injury, and easy acceptance.

　　(6) Vaginal irrigation: the catheter can be inserted into the vagina, and the vagina can be repeatedly irrigated under pressure with 40% achillea oil. Sometimes small foreign objects such as sand and wheat grains can be flushed out, and there is also an anti-inflammatory effect.

　　2. Local treatment:After the removal of foreign objects, routine treatment should be performed for vaginitis, using a 0.5% to 1% acetic acid solution for vaginal lavage, or a potassium permanganate solution at a concentration of 1/5000 for vaginal lavage, or 5% iodophor for vaginal wiping, or topical application of erythromycin ointment. For those suspected of having leeches burrowing into the vagina, there may be only hyperemia of the vaginal mucosa and small bleeding points, and topical application of erythromycin ointment and oral anti-inflammatory medication can be given. If it is inflammatory hemorrhage or if trichomonas is found in the laboratory, metronidazole (metronidazole) 0.2g should be dissolved and inserted into the vagina once a day for 7 days. For those with other specific vaginitis, treatment should be performed according to the corresponding treatment principles. A small number of polyps on the lateral wall of the vagina should be removed and pathological examination performed. If the pathological examination shows vaginal grape-like sarcoma, chemotherapy and radical surgery are required.

　　3. Vaginal repair surgery;All patients with urinary fistula and anal fistula formation require surgical repair. The principles of surgical repair are:

　　(1) Generally, it should be waited for 3 to 6 months until inflammation subsides, scars soften, and local blood supply returns to normal before surgery.

　　(2) For those with bladder stones and inflammation, stone removal and repair should be performed after controlling the inflammation.

　　(3) For those with regular menstrual cycles, surgery should be performed 3 to 7 days after the menstrual period.

　　(4) Dexamethasone should be administered before surgery if necessary to promote scar softening.

　　(5) A bath with potassium permanganate solution at a concentration of 1/5000 should be taken 3 to 5 days before surgery, and those undergoing anal fistula repair should start a low-fiber diet 3 days before surgery and take norfloxacin or metronidazole orally to control intestinal bacteria.

　　(6) A catheter should be left in place for 7 to 14 days after the repair of a urinary fistula to ensure continuous and smooth bladder drainage and prevent urinary tract infection. After the repair of an anal fistula, opium alkaloids should be taken to control defecation for 4 to 5 days.