MUMBAI: An increasing number of city doctors are reporting cases of pre-pubertal girls—especially those in the six- to 11-year age group—abusing themselves either on purpose or unwittingly by inserting objects into their vagina. When Anika Kapoor (8, name changed) complained of vaginal itching and a burning sensation "down there", her mother assumed it was a natural physiological problem. But in the course of a week, Anika's condition worsened and her vaginal area began emitting a foul-smelling white discharge. A visit to a gynaecologist at Kohinoor Hospital in Kurla turned the Kapoors' world upside down.

"We did an external examination and found that her hymen was not completely intact, and there were slight aberrations," said Dr Anjali Talwalkar. "A sonography revealed the presence of a foreign body in her vagina." It was a wad of paper. Initially doctors suspected abuse , but through a series of counselling sessions, they realized that she had inserted the paper into her vagina.

Anika's behaviour is not as unusual as her parents believe it to be; other doctors, too have encountered and treated such cases.

Is it sexual curiosity, the lack of communication with their parents or a reaction to sexual abuse that cause pre-pubertal girls to abuse themselves?

Most doctors put it down to curiosity, which is a natural part of growing up. Children are prone to touching themselves, and parents have to learn to deal with this behaviour in a manner that does not scare the child, say psychiatrists. According to Dr Anjali Talwalkar who treated Anika, the girl denied that she had been abused. "When I asked the mother if she was aware of any incident where her daughter had been abused, she replied in the negative. She denied being a victim of any untoward behaviour," Talwalkar said.

It was not possible to do a vaginal examination, which is done with the finger, as the vagina of girls Anika’s age is very small. "We had to put the child under anaesthesia and conducted a vaginal exploration. We used a small instrument to retract the vagina and remove the foreign body," she added. During her follow-up visits, doctors tried to ask her about how the rolled up piece of paper entered her vagina. "It was during these sessions that Anika said she had put the piece of paper on the underside of her panty and that it may have entered when she pulled up the garment," said the doctor, adding that on further probing, she turned defensive and hostile.

Dr Y S Nandanwar, head of gynaecology at Sion Hospital, says that his unit performs foreign body removal surgeries in pre-teens twice a year. "We have received cases where we have had to remove small pieces of soap or a hairpin. It’s hard to determine if it’s accidental or intentional," he said, adding that sexuality starts from day one of a child’s birth, though the child is not conscious about this. "Children may not understand what they are doing, but they may have seen or heard about."

Often, parents are uncomfortable discussing this topic. One parent at a US-based health and sex education website said that she had walked into her seven-year-old daughter’s room to find her on the floor "naked from waist down" playing with her dolls. "I asked her what she was doing and she started crying. I believe she was exploring her genitalia with her dolls. I told her that it was normal, that she should only use her hands to explore and that using another object might injure her. She was quite upset and didn’t want to talk about it any further," wrote the mother on the forum.

Dr Rekha Daver, head of gynaecology at JJ Hospital, said: "We occasionally get preteen girls with foul-smelling vaginal discharge. In such a case, we always find the presence of foreign bodies like small pebbles or a marble. Such a condition could have happened unintentionally while the child was playing". Dr Nikhil Datar, gynaecologist from Cooper Hospital says such cases are very rare: "It can be compared to a child putting a peanut up the nose. It’s a lack of sex education that prompts such situations."