A five-year-old girl was left bleeding and in severe pain after a physician associate (PA) wrongly prescribed a vaginal pessary, according to a report by the parliamentary and health service ombudsman. The incident occurred at a GP practice in the East Midlands in 2023, when the girl was taken to see a clinician for itching and vaginal discharge.
The PA suspected thrush and recommended a vaginal pessary and cream. The girl's mother, who believed her daughter was being seen by a GP, questioned the treatment and the size of the pessary but was reassured it was appropriate. PAs do not have prescribing rights and must have prescriptions approved by a supervising doctor, but the ombudsman found no discussion between the PA and GP before the prescription was authorised. Vaginal pessaries are not suitable for prepubescent children, and the girl's symptoms were consistent with vulvovaginitis, not thrush.
After inserting the pessary, the girl began to bleed and scream in pain, and the cream burned her skin. The mother took her to an out-of-hours doctor, but the girl was so distressed she refused an internal examination, leading the GP to raise concerns about possible sexual abuse and contact safeguarding services. It was later established the symptoms were caused by the pessary and cream, not abuse.
The ombudsman recommended the GP pay the mother £1,000 and the pharmacy pay £500, and that both organisations take action to prevent recurrence. Rebecca Hilsenrath, chief executive of the ombudsman, said the case was 'deeply troubling' and could have been avoided. The British Medical Association said the case highlighted serious consequences of inadequate supervision, and the Department of Health and Social Care said it is working to implement recommendations from a review of physician associates.
