Tampon use in patients with anorexia nervosa can cause persistent vaginal bleeding: A case series

Objective: To describe the phenomenon of persistent vaginal bleeding intwo patients with severe anorexia nervosa. Method: We report two cases of young women with severe anorexia nervosa reporting vaginal bleeding that persisted for months despite trials of topical and systemic conjugated estrogen therapy. Result: A speculum exam by a gynecologist ultimately revealed the source of the bleeding to be tampon‐induced vaginal ulcers. These resolved, along with the vaginal bleeding, with vaginal estrogen cream and cessation of tampon use. Discussion: Most patients with anorexia nervosa are amenorrheic due to reversion of the hypothalamic‐pituitary‐ovarian axis to a prepubertal state. Vaginal bleeding in patients with anorexia nervosa may trigger needless systemic hormonal treatments, radiographic studies, and multiple physician visits. A careful exam is warranted to evaluate for the presence of tampon‐induced vaginal ulcer in patients with anorexia nervosa who have persistent vaginal bleeding. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2010)