There was a copper intrauterine device (IUD) protruding from a calculus. We were unable to insert a speculum and palpated a 4 cm, rock hard, yellow, and brown textured mass in the distal vagina, which we then manually extracted in the emergency room.
Urine covered the perineum and stretcher. In our emergency room, we performed a physical examination on a bariatric stretcher without stirrups, requiring the assistance of five staff members. A specialist in female pelvic medicine and reconstructive surgery had evaluated her and advised behavioral changes as she was not felt to be a surgical candidate. Her gynecologic history included stage II pelvic organ prolapse, frequent urinary tract infections (UTIs), and mixed stress, urge, and functional urinary incontinence. She was able to perform most of her activities of daily living, and she could ambulate with a walker but often used a wheelchair. Her past medical history included hypertension, atrial flutter, obstructive sleep apnea, obesity hypoventilation, type II diabetes, and chronic kidney disease. Due to equipment weight limits, this emergency room was unable to obtain imaging and transferred her to a tertiary medical center.
Her exam was notable for a large, textured mass in her vagina. A 59-year-old woman with a body mass index (BMI) of 72 kg/m 2 presented to a community hospital for acute onset, severe vaginal pain.
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