A 6-year-old girl presents with a 1-year history of vaginal bleeding. The child had been evaluated 1 year prior for the same complaint by pediatric endocrinology. Physical examination was unremarkable at that time except for a body mass index (BMI) of 23.47 (above 95th percentile). Pubic and breast development were at Tanner Stage 1, and laboratory findings were essentially within normal limits including glucose 105 mg/dL (74-106), creatinine 0.4 mg/dL, potassium 4.4 mmol/L (3.5-5.1), CO 2 22 mmol/L (22-30), free T4 0.87 ng/dL (0.78-2.19), androstenedione <15.0 ng/dL (30-240), 17-OH progesterone <40 ng/dL (<100), and estradiol <19 pg/mL (<20). Minimally elevated laboratory findings included sodium 146 mmol/L (137-145), thyroid-stimulating hormone 4.85 µIU/mL (0.47-4.68), and dehydroepiandrosterone 1.7 ng/ml (0.3-1.3). Bone age for her chronological age of 5 and 9/12 years was advanced at approximately 7 and 10/12 years to 8 and 10/12 years. Transabdominal pelvic ultrasound revealed no structural abnormalities with normal female anatomy. The patient was lost to follow-up due to removal from mother's custody by Child Protective Services (CPS) for suspected sexual abuse. While in CPS custody, the girl displayed hypersexual and masturbatory behavior. During this timeframe, the patient required the use of a panty liner to manage vaginal bleeding, prompting CPS to resume evaluation of the origin of her vaginal bleeding, and the child was referred to gynecology. The current physical examination was unremarkable and revealed a BMI of 22.11 (above 95th percentile). Breast and pubic development continued at Tanner Stage 1. Hospital CourseIn order to elucidate the cause of vaginal bleeding, vaginoscopy under general anesthesia was performed in the operating room with the patient in frog leg position. Vaginal examination revealed erythematous labia majora, without tears or abnormalities of the hymen. Foulsmelling vaginal odor was present. Vaginal swabs were sent for gonorrhea and chlamydia cultures. On insertion of the pediatric cystoscope, an unknown foreign object was visualized within the vaginal canal. Removal of the object revealed significant erosion into the lateral walls of the vaginal canal, as well 3 additional plastic objects of undetermined origin (Figure 1). The vaginal tissue of the sidewalls and vaginal fornices had become hypertrophic and partially embedded the foreign bodies, indicating that they had been there for an extended period of time. Due to possible erosion into the abdominal cavity by the foreign bodies, the vagina was filled with Gastrograffin and plain film abdominal x-rays were obtained in the operating room, confirming the absence of abdominal penetration.The patient is currently in custody of the state as child abuse allegations are being investigated. Consultation with pediatric endocrinology is also scheduled as follow-up for the elevated BMI, bone age, and laboratory studies. The vaginal bleeding has ceased. Final DiagnosisVaginal bleeding due to erosion of vaginal wall due to foreign bodie...