Potash Alum-induced Chemical Vaginitis Masquerading as Vulvovaginal Malignancy: A Case Report on the Perils of Digital Health Misinformation

Potash Alum-induced Chemical Vaginitis Masquerading as Vulvovaginal Malignancy: A Case Report on the Perils of Digital Health Misinformation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Potash Alum-induced Chemical Vaginitis Masquerading as Vulvovaginal Malignancy: A Case Report on the Perils of Digital Health Misinformation Lokendra Bata, Jebish Pradhan, Sumana Thapa, Mili Koirala, Niranjan Chapagain, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9523233/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Vaginal discharge is a common gynecological complaint among women of reproductive age in low- and middle-income countries, including Nepal. However, formal healthcare utilization remains low due to stigma and access barriers. This creates conditions favorable to self-medication based on unverified social media content. Case Presentation: A 33-year-old multiparous woman presented with severe lower abdominal pain and progressive vulval swelling for three days, with chronic whitish vaginal discharge for several months, but had not sought medical care due to shame. Directed history-taking revealed self-insertion of solid potash alum fragments into the vaginal canal after watching a social media video recommending it as a home remedy. On examination, the vaginal introitus was narrowed with wart-like lesional changes, diffuse mucosal exfoliation, blackish flaky discharge, and a hard, irregular intravaginal mass, raising initial suspicion for vulvovaginal malignancy, condyloma acuminata, or retained foreign body. Investigations showed leukocytosis with neutrophilia; abdomen and pelvis ultrasonography was normal. A 2×2 cm alum fragment was retrieved under aseptic precautions. The vaginal canal was irrigated with normal saline; empirical broad-spectrum antibiotics and intravenous analgesia were administered. The patient was discharged on day four. At one-week follow-up, mucosal healing was complete, and discharge had resolved. Pap smear was negative for intraepithelial lesion or malignancy. Histopathological examination showed degenerated tissue with foreign particles and no evidence of granuloma, dysplasia, or malignancy, confirming chemical injury from the self-inserted alum. Conclusions: Self-insertion of solid potash alum caused severe chemical vaginitis closely mimicking vulvovaginal malignancy. Digital health misinformation poses direct patient safety risks, and non-judgmental elicitation of self-treatment history is essential in atypical gynecological emergencies. case report chemical vaginitis digital health misinformation potash alum social media vaginal foreign body vulvovaginal malignancy Figures Figure 1 Figure 2 Figure 3 1. Background Vaginal discharge is a frequent gynecological complaint in women of reproductive age worldwide, with a higher burden in low and middle-income countries.( 1 ) A population-based survey in Nepal estimates a self-reported prevalence of up to 34% women with troublesome vaginal discharge.( 2 ) Despite the availability of safe and effective treatments, utilization of formal health services remains low due to stigma, poor reproductive health literacy, and limited access to the services itself.( 3 , 4 ) The gap between the burden and healthcare-seeking behavior leads to self-medication practice and reliance on unverified home remedies.( 5 , 6 ) The rapidly evolving social media platforms have transformed the health information landscape, enabling wide dissemination of unscrutinized reproductive health content to vulnerable populations.( 6 , 7 ) Potassium aluminum sulfate (Potash alum, KAl(SO₄)₂.12H₂O) is a naturally occurring mineral that exhibits strong astringent, hemostatic, and in-vitro antimicrobial activity.( 8 , 9 ) It is traditionally used to treat wounds and chronic ulcers, and was also applied for vaginal tightening to improve the restitution of the vagina.( 9 – 12 ) The alum produces a strongly acidic environment (pH ~ 3.2–3.5), and its uncontrolled application to unprotected vaginal mucosa carries a significant risk of chemical burns and mucosal induration.( 11 ) Such severe chemical injuries, or the presence of retained foreign bodies, can create a complex clinical picture that mimics presentation of genital malignancy.( 13 – 15 ) Reports of vaginal chemical injury from alum remain scarce in the indexed literature. ( 12 ) We present a case in which self-insertion of alum fragments, motivated by social media information, resulted in severe chemical vaginitis that closely resembled vulvovaginal malignancy and required emergency intervention. 2. Case Presentation 2.1 Case History and Timeline A 33-year-old multiparous (para 3 live 3) woman presented to the emergency department with severe lower abdominal pain and vulval swelling for three days. The pain was gradual, dull-aching, non-radiating, with no aggravating or relieving factors. The swelling was sudden-onset, progressive, and associated with discomfort per vaginum. After the examination was done, the findings were surprising, and a further detailed history was warranted. In the pursuit, the patient disclosed that she had symptoms like chronic whitish vaginal discharge for the past several months and was ashamed to visit the medical service. In an attempt to self-treat the condition, she reported watching a video on social media that recommended the insertion of potash alum into the vaginal canal as a home remedy. The idea was further endorsed by her family friend. Following the advice, the patient used the alum fragments around the introitus and inserted the pieces into the vaginal canal. Over the subsequent three days, she developed progressive vulval swelling, severe pain, and difficulty walking, which ultimately prompted her to seek emergency medical care. 2.2 Clinical Examination The patient was conscious, oriented, and hemodynamically stable, but was in significant distress due to pain and discomfort. Abdominal examination revealed a soft, non-tender abdomen without guarding or rigidity; bowel sounds were present. Gynecological examination was initially challenging because of the narrowing of the vaginal introitus. Inspection of the vulva denoted wart-like lesions from and around the introitus. Upon adequate lubrication and gentle instrumentation, a per speculum examination was performed, which revealed diffuse exfoliation of vaginal mucosa accompanied by blackish flaky discharge. (Fig. 1 ) Per vaginal examination revealed roughness in the left adnexal region; however, no distinct pelvic mass was identified. A hard, irregular mass-like structure was palpable in the vaginal vault. 2.3 Differential Diagnosis Condyloma acuminata was suspected, given the verrucous appearance of the lesion on initial inspection of the vulval region. Vulvovaginal malignancy was then considered due to the presence of a hard, irregular lesion and acute diffuse mucosal changes. Infective etiologies such as severe vulvovaginitis were included in the differential owing to the presence of discharge and inflammatory findings. Additionally, the possibility of a retained vaginal foreign body was considered, particularly in the context of vaginal stenosis and localized tissue injury. Finally, chemical vaginitis resulting from exposure to irritant substances was brought in, following detailed history-taking, which revealed the insertion of potash alum. 2.4 Initial Investigations Baseline investigations demonstrated leukocytosis (Total Leukocyte Count: 16.59 ×10³/µL; reference range: 4–11×10³/µL) with neutrophilic predominance (79.74%), suggestive of an inflammatory or infectious process. Renal and liver function tests were within normal limits. Urinary β-hCG was negative, ruling out the pregnancy-related pathology. Ultrasonography of the abdomen and pelvis revealed normal uterine and adnexal anatomy with no evidence of pelvic abscess, retained products of conception, or free fluid. 2.5 Therapeutic Intervention Gentle irrigation of the vaginal canal was performed with 1 liter of Normal Saline (NS) twice daily, to remove residual debris and chemical irritants, and promote mucosal healing. Empirical broad-spectrum antibiotics were administered to prevent secondary infection of the chemically injured mucosa. Intravenous analgesics were given for pain management. 2.6 Outcome and Follow-up Following the removal of the foreign body and supportive treatment, the patient reported significant symptomatic relief, with a decrease in intensity of pain and swelling per vaginum. She was hemodynamically stable during hospitalization and was discharged on the fourth day of admission with instructions for follow-up. Figure 3. Follow-up speculum examination demonstrating a patent vaginal canal with normal mucosal appearance and absence of lesions, indicating complete mucosal healing post-extraction. At one-week follow-up, the patient demonstrated marked clinical improvement with healing of the vaginal mucosa and complete resolution of discharge. (Fig. 3) Pap smear was done, and was negative for intraepithelial lesion or malignancy. Histopathological examination revealed degenerated cervical tissue with a few foreign particles and no evidence of granuloma, dysplasia, or malignancy. These findings confirmed the diagnosis of vaginal chemical injury due to self-inserted potash alum fragments. 3. Discussion This case highlights a serious and potentially life-threatening consequence arising from the self-insertion of potash alum fragments into the vaginal canal, prompted by digital health misinformation. Potash alum or potassium aluminium sulfate, commonly called “Phitkiry” in Nepalese households, is a crystalline double sulfate salt, with a long history of use as a traditional medicine worldwide. It is recognized for its severe astringent, styptic, and antimicrobial properties.( 8 , 10 , 11 ) In aqueous solution, it undergoes hydrolysis and yields aluminum hydroxide and hydronium ions, which neutralize charges on plasma proteins and precipitate them. This results in contraction of superficial tissue layers and cessation of secretions, which explains its clinical uses as a topical hemostatic agent.( 10 ) Unlike the external skin, the vaginal mucosa lacks a protective keratin layer, offering minimal epidermal barrier, and sustaining earlier and more extensive damage upon contact with acid agents. Solid alum dissolves and produces extremely high acid concentrations locally, resulting in tissue damage typical of acid coagulation necrosis with protein precipitation and vascular damage.( 11 ) Although some studies demonstrate antifungal activity of potash alum against Candida with improvement of symptoms, safety is still unknown, as even regulated preparations are known to cause irritation. Its intravaginal use is not authorized, and using raw crystals is dangerous and unsupported.( 8 , 11 ) The patient’s decision to self-treat was prompted by a social media video, illustrating how the online platforms have become critical channels for the rapid dissemination of unverified and potentially harmful health advice.( 6 , 7 , 16 ) Unregulated health information on digital platforms spreads more easily than evidence-based scientific knowledge.( 16 ) This often leads to promotion of unproven treatments and misleading interpretations of available evidence, which can delay proper medical care and increase the risk of physical harm.( 7 ) Many women do not seek medical care promptly due to the prevailing stigma associated with vaginal discharge and minimal health-seeking behavior in low and middle-income countries.( 3 , 4 ) This makes misinformation driven self-treatment common and dangerous when combined with high symptoms and internet use. The clinical presentation, characterized by vulval edema, mucosal exfoliation, blackish discharge, a hard irregular intravaginal mass, and bilateral fornix roughness, presented a diagnostic challenge and initially raised the suspicion of vulvovaginal malignancy, condyloma acuminata, or a retained foreign body. The retained vaginal foreign bodies or chronic irritants cause chronic inflammation, granulation tissue, and fibrosis that mimic neoplastic lesions.( 13 , 14 , 17 , 18 ) This chemical insult triggered inflammation, causing leukocytosis with neutrophilia and ultimately leading to mucosal exfoliation, necrosis, and foreign body reaction that occurred in our case. Extraction of the irritant potash alum fragment, followed by the use of gentle saline irrigation and empirical antibiotics, was instrumental in promoting mucosal healing and preventing secondary infection of the necrotic tissue.( 12 , 18 ) The eventual resolution of all features following foreign body extraction and supportive care, with histopathological confirmation of chemical injury and foreign body reaction, confirmed that the tissue changes were reactive rather than neoplastic. This case emphasizes how important it is to take a complete history in gynecologic emergencies. Only by probing was self-treatment was the cause found. When there is rapid mucosal damage, mass-like lesions, and previous discharge, clinicians should suspect chemical injury in settings where misinformation is pervasive. Direct, nonjudgmental questioning is essential because stigma prevents disclosure. 4. Conclusion This case highlights severe chemical vaginitis mimicking vulvovaginal malignancy following intravaginal insertion of potash alum driven by social media misinformation. It underscores the potential for unverified digital health content to cause significant physical harm. Clinicians should maintain a high index of suspicion for chemical injury in atypical presentations and prioritize nonjudgmental history-taking to uncover self-treatment practices. Strengthening public health education and digital health literacy is essential to prevent such avoidable complications. Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Written informed consent for publication of their clinical details and clinical images was obtained from the relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Availability of data and materials: Not applicable. Code Availability: Not applicable. Competing interests: The authors declare that they have no competing interests. Funding : The authors received no specific funding for this work. Authors' contributions: LBS: Conceptualization, Data Curation, Methodology, Project Administration, Visualization, Writing- original draft, review & editing; JP: Conceptualization, Data Curation, Methodology, Project Administration, Visualization, Writing- original draft, review & editing; ST: Conceptualization, Methodology, Resources, Supervision, Writing – review & editing; MK: Conceptualization, Data Curation, Methodology, Project Administration, Writing – original draft, review & editing; NC: Conceptualization, Data Curation, Methodology, Resources, Writing – original draft, review & editing PK: Conceptualization, Data curation, Resources, Visualization, Writing – review & editing Acknowledgements: We thank the entire medical team, including the nursing staff, for their dedicated care. We also acknowledge the patient and her family for their cooperation. References Shrestha S, Shakya S, Infanti JJ, Skovlund E, Simpson MR, Lonnee-Hoffmann RAM. Implementing point-of-care tests to optimize antibiotic use for vaginal discharge: a study protocol for a randomized controlled trial in Nepal. Trials. 2025 Dec 12;27:41. doi: 10.1186/s13063-025-09333-4 Shakya S, Thingulstad S, Syversen U, Nordbø SA, Madhup S, Vaidya K, et al. Prevalence of Sexually Transmitted Infections among Married Women in Rural Nepal. Infect Dis Obstet Gynecol. 2018;2018(1):4980396. doi: 10.1155/2018/4980396 Patel V, Andrew G, Pelto PJ. The psychological and social contexts of complaints of abnormal vaginal discharge: A study of illness narratives in India. J Psychosom Res. 2008 Mar 1;64(3):255–62. doi:10.1016/j.jpsychores.2007.10.015 Hilber A, Hull T, Preston-Whyte E, Bagnol B, Smit J, Wacharasin C, et al. A cross-cultural study of vaginal practices and sexuality: Implications for sexual health. Soc Sci Med. 2009 Nov 1;70:392–400. doi:10.1016/j.socscimed.2009.10.023 Ghimire P, Pant P, Khatiwada S, Ranjit S, Malla S, Pandey S. Self-medication practice in Kathmandu Metropolitan City: A cross-sectional study. SAGE Open Med. 2023 Mar 3;11:20503121231158966. doi:10.1177/20503121231158966 Yeung AWK, Tosevska A, Klager E, Eibensteiner F, Tsagkaris C, Parvanov ED, et al. Medical and Health-Related Misinformation on Social Media: Bibliometric Study of the Scientific Literature. J Med Internet Res. 2022 Jan 25;24(1):e28152. doi:10.2196/28152 Borges do Nascimento IJ, Pizarro AB, Almeida JM, Azzopardi-Muscat N, Gonçalves MA, Björklund M, et al. Infodemics and health misinformation: a systematic review of reviews. Bull World Health Organ. 2022 Sep 1;100(9):544–61. doi:10.2471/BLT.21.287654 Irshad M, Younas M, Qureshi AU, Hameed A. Determination of Minimum Inhibitory and Fungicidal Concentrations of Potash Alum Against Clinical Isolates of Candida albicans. J Pak Dent Assoc. 2020;29(4):235-8. Available from: https://www.jpda.com.pk/determination-of-minimum-inhibitory-and-fungicidal-concentrations-of-potash-alum-against-clinical-isolates-of-candida-albicans-2 Shalli FG, Taufikurohmah T, Suyatno, Apriyosa E. Preliminary studies on antifungal and antibacterial activity of alum as medicine preparation for vaginal discharge. Int J Res -GRANTHAALAYAH. 2020 Jul 9;8(6):188–95. doi:10.29121/granthaalayah.v8.i6.2020.464 Alzomor AK, Moharram AS, Absi NMA. Formulation and evaluation of potash alum as deodorant lotion and after shaving astringent as cream and gel. Int Curr Pharm J. 2014 Jan 2;3(2):228–33. doi:10.3329/icpj.v3i2.17512 Sangy S, Tansaz M, Hajimehdipoor H, Ara L, Sangy S, Mazinani M. Potassium Alum Vaginal Suppository: Irritation Assessment in Rabbit. Res J Pharmacogn. 2024 Jan 1;11(1):65–9. doi:10.22127/rjp.2023.185643 nd International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 24-27 May 2022, Tallinn, Estonia. Clin Toxicol. 2022 May 2;60(sup1):1–108. doi:10.1080/15563650.2022.2054576 Ciebiera M, Słabuszewska-Jóźwiak A, Ledowicz W, Jakiel G. Vaginal foreign body mimicking cervical cancer in postmenopausal woman – case study. Menopause Rev Menopauzalny. 2015;14(3):208–10. doi:10.5114/pm.2015.54348 Li F, Yin R, Jiang H, Luo G. Adult vaginal foreign body misdiagnosed as cervical cancer: a case report and literature review. Clin Exp Obstet Gynecol. 2019 Jun 10;46(3):476–8. doi: 10.12891/ceog4479.2019 Simon DA, Berry S, Brannian J, Hansen K. Recurrent, purulent vaginal discharge associated with longstanding presence of a foreign body and vaginal stenosis. J Pediatr Adolesc Gynecol. 2003 Dec;16(6):361–3. doi: 10.1016/j.jpag.2003.09.006 Suarez-Lledo V, Alvarez-Galvez J. Prevalence of Health Misinformation on Social Media: Systematic Review. J Med Internet Res. 2021 Jan 20;23(1):e17187. doi: 10.2196/17187 Panda S, Das A, Das R, Sharma N, Jante V. An Unusual Case of Retained Foreign Body in the Vagina With Vaginal Fibrosis. Cureus. 2022 Jan 5;14(1):e20956. doi: 10.7759/cureus.20956 Sharma N, Vegda DS, Gandhi VS. Vaginal Foreign Body Forgotten for 20 Years in a Postmenopausal Female: A Case Report. Cureus. 2022 Dec 30;14(12):e33132. doi: 10.7759/cureus.33132 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 02 May, 2026 Reviewers invited by journal 30 Apr, 2026 Editor assigned by journal 27 Apr, 2026 Submission checks completed at journal 27 Apr, 2026 First submitted to journal 25 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9523233","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":633416622,"identity":"933173f3-1d10-436f-8d7c-aa2a557af57a","order_by":0,"name":"Lokendra Bata","email":"","orcid":"","institution":"Shree Birendra Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lokendra","middleName":"","lastName":"Bata","suffix":""},{"id":633416626,"identity":"f7733a91-f5ee-450e-aead-87d860812177","order_by":1,"name":"Jebish Pradhan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBACxgYehgOMDSBmDhBXADEzcwMpWs6AtDDi18LAwAPSB9XC2AYxBq8G5vbegwd/7riTz9+ee/Bz4bzaaP52oJYfFdtwO6znXMJh3jPPLGeceZcsPXPb8dwZhxkbGHvO3MatZUaOwWHGtsMGDDdyDKR5tx3LbQBqYWZsw6Nl/huDgz+BWuRv5Bj/5p1zLHc+QS0zeAwO8AK1GNzIMZPmbajJ3UBQS08e0C9tzwwMz7wxs+Y5diB3I1DLQXx+MWw/e/jjz7Y7BnLHc4xv89TU5c47f/jggx8VeLQ0gKkDMP5hVC42IM+AqqYOn+JRMApGwSgYoQAA3B9ljOl/Dn0AAAAASUVORK5CYII=","orcid":"","institution":"Nepalese Army Institute of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Jebish","middleName":"","lastName":"Pradhan","suffix":""},{"id":633416639,"identity":"71865fab-16a0-494e-933e-6a118ffb7e22","order_by":2,"name":"Sumana Thapa","email":"","orcid":"","institution":"Shree Birendra Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sumana","middleName":"","lastName":"Thapa","suffix":""},{"id":633416642,"identity":"b6f20954-c3db-48e2-adf1-35228729152a","order_by":3,"name":"Mili Koirala","email":"","orcid":"","institution":"Nepalese Army Institute of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mili","middleName":"","lastName":"Koirala","suffix":""},{"id":633416644,"identity":"356ffab2-d4cf-4384-9c05-e56aa09e6850","order_by":4,"name":"Niranjan Chapagain","email":"","orcid":"","institution":"Nepalese Army Institute of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Niranjan","middleName":"","lastName":"Chapagain","suffix":""},{"id":633416647,"identity":"bf76a35d-33b1-4421-9750-c2c13440e932","order_by":5,"name":"Parool Khadka","email":"","orcid":"","institution":"Shree Birendra Hospital","correspondingAuthor":false,"prefix":"","firstName":"Parool","middleName":"","lastName":"Khadka","suffix":""}],"badges":[],"createdAt":"2026-04-25 07:24:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9523233/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9523233/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108959755,"identity":"98bf10b0-63d0-4557-8d69-be098cf84f17","added_by":"auto","created_at":"2026-05-11 08:32:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":198658,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePer speculum examination showing diffuse swelling and exfoliation of vaginal mucosa.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9523233/v1/d4efc0ca4a9180daad2cce2d.png"},{"id":108959753,"identity":"7ef1dd91-ff0c-4c39-9c66-453a6b5cf071","added_by":"auto","created_at":"2026-05-11 08:32:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":407576,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eRetrieval of a foreign body from the introitus.\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003e\u003cem\u003e(A) Intraoperative image demonstrating the extraction of a hard intravaginal crystal-like foreign body under aseptic precautions. (B) Retrieved specimens: red-capped container showing the extracted potash alum fragment (~2 × 2 cm), and blue-capped container containing blackish necrotic tissue obtained from the excoriated vaginal mucosa.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9523233/v1/57164cdc93571d03934dbae6.png"},{"id":108978220,"identity":"49c56a3f-324a-4f6b-90a9-1b54aae8d0fe","added_by":"auto","created_at":"2026-05-11 11:35:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":270051,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFollow-up speculum examination demonstrating a patent vaginal canal with normal mucosal appearance and absence of lesions, indicating complete mucosal healing post-extraction.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9523233/v1/223fc65326e62fce66894044.png"},{"id":108979768,"identity":"ed65f759-4627-43a4-a73a-7cf2a9f3cf31","added_by":"auto","created_at":"2026-05-11 12:01:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1358458,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9523233/v1/d1cef211-c890-4165-9944-03a0cab1fc52.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Potash Alum-induced Chemical Vaginitis Masquerading as Vulvovaginal Malignancy: A Case Report on the Perils of Digital Health Misinformation","fulltext":[{"header":"1. Background","content":"\u003cp\u003eVaginal discharge is a frequent gynecological complaint in women of reproductive age worldwide, with a higher burden in low and middle-income countries.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) A population-based survey in Nepal estimates a self-reported prevalence of up to 34% women with troublesome vaginal discharge.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Despite the availability of safe and effective treatments, utilization of formal health services remains low due to stigma, poor reproductive health literacy, and limited access to the services itself.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe gap between the burden and healthcare-seeking behavior leads to self-medication practice and reliance on unverified home remedies.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) The rapidly evolving social media platforms have transformed the health information landscape, enabling wide dissemination of unscrutinized reproductive health content to vulnerable populations.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePotassium aluminum sulfate (Potash alum, KAl(SO₄)₂.12H₂O) is a naturally occurring mineral that exhibits strong astringent, hemostatic, and in-vitro antimicrobial activity.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) It is traditionally used to treat wounds and chronic ulcers, and was also applied for vaginal tightening to improve the restitution of the vagina.(\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) The alum produces a strongly acidic environment (pH\u0026thinsp;~\u0026thinsp;3.2\u0026ndash;3.5), and its uncontrolled application to unprotected vaginal mucosa carries a significant risk of chemical burns and mucosal induration.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Such severe chemical injuries, or the presence of retained foreign bodies, can create a complex clinical picture that mimics presentation of genital malignancy.(\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Reports of vaginal chemical injury from alum remain scarce in the indexed literature. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWe present a case in which self-insertion of alum fragments, motivated by social media information, resulted in severe chemical vaginitis that closely resembled vulvovaginal malignancy and required emergency intervention.\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Case History and Timeline\u003c/h2\u003e \u003cp\u003eA 33-year-old multiparous (para 3 live 3) woman presented to the emergency department with severe lower abdominal pain and vulval swelling for three days. The pain was gradual, dull-aching, non-radiating, with no aggravating or relieving factors. The swelling was sudden-onset, progressive, and associated with discomfort per vaginum.\u003c/p\u003e \u003cp\u003eAfter the examination was done, the findings were surprising, and a further detailed history was warranted. In the pursuit, the patient disclosed that she had symptoms like chronic whitish vaginal discharge for the past several months and was ashamed to visit the medical service. In an attempt to self-treat the condition, she reported watching a video on social media that recommended the insertion of potash alum into the vaginal canal as a home remedy. The idea was further endorsed by her family friend. Following the advice, the patient used the alum fragments around the introitus and inserted the pieces into the vaginal canal. Over the subsequent three days, she developed progressive vulval swelling, severe pain, and difficulty walking, which ultimately prompted her to seek emergency medical care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Clinical Examination\u003c/h2\u003e \u003cp\u003eThe patient was conscious, oriented, and hemodynamically stable, but was in significant distress due to pain and discomfort. Abdominal examination revealed a soft, non-tender abdomen without guarding or rigidity; bowel sounds were present.\u003c/p\u003e \u003cp\u003eGynecological examination was initially challenging because of the narrowing of the vaginal introitus. Inspection of the vulva denoted wart-like lesions from and around the introitus. Upon adequate lubrication and gentle instrumentation, a per speculum examination was performed, which revealed diffuse exfoliation of vaginal mucosa accompanied by blackish flaky discharge. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) Per vaginal examination revealed roughness in the left adnexal region; however, no distinct pelvic mass was identified. A hard, irregular mass-like structure was palpable in the vaginal vault.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Differential Diagnosis\u003c/h2\u003e \u003cp\u003eCondyloma acuminata was suspected, given the verrucous appearance of the lesion on initial inspection of the vulval region. Vulvovaginal malignancy was then considered due to the presence of a hard, irregular lesion and acute diffuse mucosal changes. Infective etiologies such as severe vulvovaginitis were included in the differential owing to the presence of discharge and inflammatory findings. Additionally, the possibility of a retained vaginal foreign body was considered, particularly in the context of vaginal stenosis and localized tissue injury. Finally, chemical vaginitis resulting from exposure to irritant substances was brought in, following detailed history-taking, which revealed the insertion of potash alum.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Initial Investigations\u003c/h2\u003e \u003cp\u003eBaseline investigations demonstrated leukocytosis (Total Leukocyte Count: 16.59 \u0026times;10\u0026sup3;/\u0026micro;L; reference range: 4\u0026ndash;11\u0026times;10\u0026sup3;/\u0026micro;L) with neutrophilic predominance (79.74%), suggestive of an inflammatory or infectious process. Renal and liver function tests were within normal limits.\u003c/p\u003e \u003cp\u003eUrinary β-hCG was negative, ruling out the pregnancy-related pathology. Ultrasonography of the abdomen and pelvis revealed normal uterine and adnexal anatomy with no evidence of pelvic abscess, retained products of conception, or free fluid.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Therapeutic Intervention\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGentle irrigation of the vaginal canal was performed with 1 liter of Normal Saline (NS) twice daily, to remove residual debris and chemical irritants, and promote mucosal healing. Empirical broad-spectrum antibiotics were administered to prevent secondary infection of the chemically injured mucosa. Intravenous analgesics were given for pain management.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Outcome and Follow-up\u003c/h2\u003e \u003cp\u003e Following the removal of the foreign body and supportive treatment, the patient reported significant symptomatic relief, with a decrease in intensity of pain and swelling per vaginum. She was hemodynamically stable during hospitalization and was discharged on the fourth day of admission with instructions for follow-up.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 3.\u003c/b\u003e \u003cem\u003eFollow-up speculum examination demonstrating a patent vaginal canal with normal mucosal appearance and absence of lesions, indicating complete mucosal healing post-extraction.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAt one-week follow-up, the patient demonstrated marked clinical improvement with healing of the vaginal mucosa and complete resolution of discharge. (Fig.\u0026nbsp;3) Pap smear was done, and was negative for intraepithelial lesion or malignancy. Histopathological examination revealed degenerated cervical tissue with a few foreign particles and no evidence of granuloma, dysplasia, or malignancy. These findings confirmed the diagnosis of vaginal chemical injury due to self-inserted potash alum fragments.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThis case highlights a serious and potentially life-threatening consequence arising from the self-insertion of potash alum fragments into the vaginal canal, prompted by digital health misinformation. Potash alum or potassium aluminium sulfate, commonly called \u003cem\u003e\u0026ldquo;Phitkiry\u0026rdquo;\u003c/em\u003e in Nepalese households, is a crystalline double sulfate salt, with a long history of use as a traditional medicine worldwide. It is recognized for its severe astringent, styptic, and antimicrobial properties.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn aqueous solution, it undergoes hydrolysis and yields aluminum hydroxide and hydronium ions, which neutralize charges on plasma proteins and precipitate them. This results in contraction of superficial tissue layers and cessation of secretions, which explains its clinical uses as a topical hemostatic agent.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Unlike the external skin, the vaginal mucosa lacks a protective keratin layer, offering minimal epidermal barrier, and sustaining earlier and more extensive damage upon contact with acid agents. Solid alum dissolves and produces extremely high acid concentrations locally, resulting in tissue damage typical of acid coagulation necrosis with protein precipitation and vascular damage.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAlthough some studies demonstrate antifungal activity of potash alum against Candida with improvement of symptoms, safety is still unknown, as even regulated preparations are known to cause irritation. Its intravaginal use is not authorized, and using raw crystals is dangerous and unsupported.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe patient\u0026rsquo;s decision to self-treat was prompted by a social media video, illustrating how the online platforms have become critical channels for the rapid dissemination of unverified and potentially harmful health advice.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Unregulated health information on digital platforms spreads more easily than evidence-based scientific knowledge.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) This often leads to promotion of unproven treatments and misleading interpretations of available evidence, which can delay proper medical care and increase the risk of physical harm.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Many women do not seek medical care promptly due to the prevailing stigma associated with vaginal discharge and minimal health-seeking behavior in low and middle-income countries.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) This makes misinformation driven self-treatment common and dangerous when combined with high symptoms and internet use.\u003c/p\u003e \u003cp\u003eThe clinical presentation, characterized by vulval edema, mucosal exfoliation, blackish discharge, a hard irregular intravaginal mass, and bilateral fornix roughness, presented a diagnostic challenge and initially raised the suspicion of vulvovaginal malignancy, condyloma acuminata, or a retained foreign body. The retained vaginal foreign bodies or chronic irritants cause chronic inflammation, granulation tissue, and fibrosis that mimic neoplastic lesions.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) This chemical insult triggered inflammation, causing leukocytosis with neutrophilia and ultimately leading to mucosal exfoliation, necrosis, and foreign body reaction that occurred in our case.\u003c/p\u003e \u003cp\u003eExtraction of the irritant potash alum fragment, followed by the use of gentle saline irrigation and empirical antibiotics, was instrumental in promoting mucosal healing and preventing secondary infection of the necrotic tissue.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) The eventual resolution of all features following foreign body extraction and supportive care, with histopathological confirmation of chemical injury and foreign body reaction, confirmed that the tissue changes were reactive rather than neoplastic.\u003c/p\u003e \u003cp\u003eThis case emphasizes how important it is to take a complete history in gynecologic emergencies. Only by probing was self-treatment was the cause found. When there is rapid mucosal damage, mass-like lesions, and previous discharge, clinicians should suspect chemical injury in settings where misinformation is pervasive. Direct, nonjudgmental questioning is essential because stigma prevents disclosure.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThis case highlights severe chemical vaginitis mimicking vulvovaginal malignancy following intravaginal insertion of potash alum driven by social media misinformation. It underscores the potential for unverified digital health content to cause significant physical harm. Clinicians should maintain a high index of suspicion for chemical injury in atypical presentations and prioritize nonjudgmental history-taking to uncover self-treatment practices. Strengthening public health education and digital health literacy is essential to prevent such avoidable complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Not applicable\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Written informed consent for publication of their clinical details and clinical images was obtained from the relative of the patient. A copy of the consent form is available for review by the Editor of this journal.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Not applicable.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCode Availability:\u003c/strong\u003e Not applicable.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors received no specific funding for this work.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors\u0026apos; contributions: LBS:\u003c/strong\u003e Conceptualization, Data Curation, Methodology, Project Administration, Visualization, Writing- original draft, review \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;JP:\u0026nbsp;\u003c/strong\u003eConceptualization, Data Curation, Methodology, Project Administration, Visualization, Writing- original draft, review \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;ST:\u0026nbsp;\u003c/strong\u003eConceptualization, Methodology, Resources, Supervision, Writing \u0026ndash; review \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;MK:\u0026nbsp;\u003c/strong\u003eConceptualization, Data Curation, Methodology, Project Administration, Writing \u0026ndash; original draft, review \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;NC:\u0026nbsp;\u003c/strong\u003eConceptualization, Data Curation, Methodology, Resources, Writing \u0026ndash; original draft, review \u0026amp; editing\u003cstrong\u003e\u0026nbsp;PK:\u0026nbsp;\u003c/strong\u003eConceptualization, Data curation, Resources, Visualization, Writing \u0026ndash; review \u0026amp; editing\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We thank the entire medical team, including the nursing staff, for their dedicated care. We also acknowledge the patient and her family for their cooperation.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShrestha S, Shakya S, Infanti JJ, Skovlund E, Simpson MR, Lonnee-Hoffmann RAM. Implementing point-of-care tests to optimize antibiotic use for vaginal discharge: a study protocol for a randomized controlled trial in Nepal. Trials. 2025 Dec 12;27:41. doi: 10.1186/s13063-025-09333-4 \u003c/li\u003e\n\u003cli\u003eShakya S, Thingulstad S, Syversen U, Nordb\u0026oslash; SA, Madhup S, Vaidya K, et al. Prevalence of Sexually Transmitted Infections among Married Women in Rural Nepal. Infect Dis Obstet Gynecol. 2018;2018(1):4980396. doi: 10.1155/2018/4980396\u003c/li\u003e\n\u003cli\u003ePatel V, Andrew G, Pelto PJ. The psychological and social contexts of complaints of abnormal vaginal discharge: A study of illness narratives in India. J Psychosom Res. 2008 Mar 1;64(3):255\u0026ndash;62. doi:10.1016/j.jpsychores.2007.10.015\u003c/li\u003e\n\u003cli\u003eHilber A, Hull T, Preston-Whyte E, Bagnol B, Smit J, Wacharasin C, et al. A cross-cultural study of vaginal practices and sexuality: Implications for sexual health. Soc Sci Med. 2009 Nov 1;70:392\u0026ndash;400. doi:10.1016/j.socscimed.2009.10.023\u003c/li\u003e\n\u003cli\u003eGhimire P, Pant P, Khatiwada S, Ranjit S, Malla S, Pandey S. Self-medication practice in Kathmandu Metropolitan City: A cross-sectional study. SAGE Open Med. 2023 Mar 3;11:20503121231158966. doi:10.1177/20503121231158966 \u003c/li\u003e\n\u003cli\u003eYeung AWK, Tosevska A, Klager E, Eibensteiner F, Tsagkaris C, Parvanov ED, et al. Medical and Health-Related Misinformation on Social Media: Bibliometric Study of the Scientific Literature. J Med Internet Res. 2022 Jan 25;24(1):e28152. doi:10.2196/28152 \u003c/li\u003e\n\u003cli\u003eBorges do Nascimento IJ, Pizarro AB, Almeida JM, Azzopardi-Muscat N, Gon\u0026ccedil;alves MA, Bj\u0026ouml;rklund M, et al. Infodemics and health misinformation: a systematic review of reviews. Bull World Health Organ. 2022 Sep 1;100(9):544\u0026ndash;61. doi:10.2471/BLT.21.287654 \u003c/li\u003e\n\u003cli\u003eIrshad M, Younas M, Qureshi AU, Hameed A. Determination of Minimum Inhibitory and Fungicidal Concentrations of Potash Alum Against Clinical Isolates of Candida albicans. J Pak Dent Assoc. 2020;29(4):235-8. Available from: https://www.jpda.com.pk/determination-of-minimum-inhibitory-and-fungicidal-concentrations-of-potash-alum-against-clinical-isolates-of-candida-albicans-2 \u003c/li\u003e\n\u003cli\u003eShalli FG, Taufikurohmah T, Suyatno, Apriyosa E. Preliminary studies on antifungal and antibacterial activity of alum as medicine preparation for vaginal discharge. Int J Res -GRANTHAALAYAH. 2020 Jul 9;8(6):188\u0026ndash;95. doi:10.29121/granthaalayah.v8.i6.2020.464\u003c/li\u003e\n\u003cli\u003eAlzomor AK, Moharram AS, Absi NMA. Formulation and evaluation of potash alum as deodorant lotion and after shaving astringent as cream and gel. Int Curr Pharm J. 2014 Jan 2;3(2):228\u0026ndash;33. doi:10.3329/icpj.v3i2.17512\u003c/li\u003e\n\u003cli\u003eSangy S, Tansaz M, Hajimehdipoor H, Ara L, Sangy S, Mazinani M. Potassium Alum Vaginal Suppository: Irritation Assessment in Rabbit. Res J Pharmacogn. 2024 Jan 1;11(1):65\u0026ndash;9. doi:10.22127/rjp.2023.185643\u003c/li\u003e\n\u003cli\u003end International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 24-27 May 2022, Tallinn, Estonia. Clin Toxicol. 2022 May 2;60(sup1):1\u0026ndash;108. doi:10.1080/15563650.2022.2054576\u003c/li\u003e\n\u003cli\u003eCiebiera M, Słabuszewska-J\u0026oacute;źwiak A, Ledowicz W, Jakiel G. Vaginal foreign body mimicking cervical cancer in postmenopausal woman \u0026ndash; case study. Menopause Rev Menopauzalny. 2015;14(3):208\u0026ndash;10. doi:10.5114/pm.2015.54348\u003c/li\u003e\n\u003cli\u003eLi F, Yin R, Jiang H, Luo G. Adult vaginal foreign body misdiagnosed as cervical cancer: a case report and literature review. Clin Exp Obstet Gynecol. 2019 Jun 10;46(3):476\u0026ndash;8. doi: 10.12891/ceog4479.2019\u003c/li\u003e\n\u003cli\u003eSimon DA, Berry S, Brannian J, Hansen K. Recurrent, purulent vaginal discharge associated with longstanding presence of a foreign body and vaginal stenosis. J Pediatr Adolesc Gynecol. 2003 Dec;16(6):361\u0026ndash;3. doi: 10.1016/j.jpag.2003.09.006 \u003c/li\u003e\n\u003cli\u003eSuarez-Lledo V, Alvarez-Galvez J. Prevalence of Health Misinformation on Social Media: Systematic Review. J Med Internet Res. 2021 Jan 20;23(1):e17187. doi: 10.2196/17187\u003c/li\u003e\n\u003cli\u003ePanda S, Das A, Das R, Sharma N, Jante V. An Unusual Case of Retained Foreign Body in the Vagina With Vaginal Fibrosis. Cureus. 2022 Jan 5;14(1):e20956. doi: 10.7759/cureus.20956\u003c/li\u003e\n\u003cli\u003eSharma N, Vegda DS, Gandhi VS. Vaginal Foreign Body Forgotten for 20 Years in a Postmenopausal Female: A Case Report. Cureus. 2022 Dec 30;14(12):e33132. doi: 10.7759/cureus.33132\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bulletin-of-the-national-research-centre","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnrc","sideBox":"Learn more about [Bulletin of the National Research Centre](https://BNRC.springeropen.com)","snPcode":"42269","submissionUrl":"https://submission.springernature.com/new-submission/42269/3","title":"Bulletin of the National Research Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"case report, chemical vaginitis, digital health misinformation, potash alum, social media, vaginal foreign body, vulvovaginal malignancy","lastPublishedDoi":"10.21203/rs.3.rs-9523233/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9523233/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eVaginal discharge is a common gynecological complaint among women of reproductive age in low- and middle-income countries, including Nepal. However, formal healthcare utilization remains low due to stigma and access barriers. This creates conditions favorable to self-medication based on unverified social media content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation: \u003c/strong\u003eA 33-year-old multiparous woman presented with severe lower abdominal pain and progressive vulval swelling for three days, with chronic whitish vaginal discharge for several months, but had not sought medical care due to shame. Directed history-taking revealed self-insertion of solid potash alum fragments into the vaginal canal after watching a social media video recommending it as a home remedy. On examination, the vaginal introitus was narrowed with wart-like lesional changes, diffuse mucosal exfoliation, blackish flaky discharge, and a hard, irregular intravaginal mass, raising initial suspicion for vulvovaginal malignancy, condyloma acuminata, or retained foreign body. Investigations showed leukocytosis with neutrophilia; abdomen and pelvis ultrasonography was normal. A 2×2 cm alum fragment was retrieved under aseptic precautions. The vaginal canal was irrigated with normal saline; empirical broad-spectrum antibiotics and intravenous analgesia were administered. The patient was discharged on day four. At one-week follow-up, mucosal healing was complete, and discharge had resolved. Pap smear was negative for intraepithelial lesion or malignancy. Histopathological examination showed degenerated tissue with foreign particles and no evidence of granuloma, dysplasia, or malignancy, confirming chemical injury from the self-inserted alum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eSelf-insertion of solid potash alum caused severe chemical vaginitis closely mimicking vulvovaginal malignancy. Digital health misinformation poses direct patient safety risks, and non-judgmental elicitation of self-treatment history is essential in atypical gynecological emergencies.\u003c/p\u003e","manuscriptTitle":"Potash Alum-induced Chemical Vaginitis Masquerading as Vulvovaginal Malignancy: A Case Report on the Perils of Digital Health Misinformation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 08:32:37","doi":"10.21203/rs.3.rs-9523233/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"61241056280631765107824412843212855065","date":"2026-05-02T16:26:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-30T05:16:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-27T17:18:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-27T04:54:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bulletin of the National Research Centre","date":"2026-04-25T07:13:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bulletin-of-the-national-research-centre","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnrc","sideBox":"Learn more about [Bulletin of the National Research Centre](https://BNRC.springeropen.com)","snPcode":"42269","submissionUrl":"https://submission.springernature.com/new-submission/42269/3","title":"Bulletin of the National Research Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"133dc2ac-a4c8-48c1-b5ee-7b669b784e69","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"61241056280631765107824412843212855065","date":"2026-05-02T16:26:13+00:00","index":27,"fulltext":""},{"type":"reviewersInvited","content":"45","date":"2026-04-30T05:16:32+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T08:32:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 08:32:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9523233","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9523233","identity":"rs-9523233","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}