X‑ray, extraction and a warning: what the Emelly Souza case teaches about Kegel balls, pelvic‑floor devices and safe use

Table of Contents

1. Key Highlights
2. Introduction
3. What happened: the case of Emelly Souza
4. Kegel balls, Ben Wa balls, and pompoarism: what the devices do and how people use them
5. Why Kegel balls and similar devices can become lodged
6. How clinicians assess a retained pelvic‑floor device
7. Extraction techniques: from bedside retrieval to surgical removal
8. Common complications and when they occur
9. Prevention: how to use Kegel balls and pelvic‑floor devices safely
10. How to attempt safe self‑retrieval — and when to stop
11. The role of imaging: when an X‑ray helps and when it does not
12. When to involve specialists: pelvic‑floor physiotherapists, gynecologists and emergency medicine
13. Product safety, labeling and the role of regulation
14. Practical guidance for clinicians advising patients
15. Social and psychological aspects: embarrassment, disclosure and public education
16. Practical checklist: what to do if a Kegel ball or pelvic device won’t come out
17. Broader context: pelvic‑floor health beyond devices
18. Lessons from the Souza case for consumers and clinicians
19. FAQ

Key Highlights

• Brazilian influencer Emelly Souza required an X‑ray and professional extraction after Kegel exercise balls became lodged during pompoarism; she shared the X‑ray publicly to warn others.
• Retained pelvic‑floor devices are preventable with correct device design (retrieval cords), appropriate size, hygiene and awareness of red flags; when a device cannot be retrieved, imaging and clinician‑led removal minimize harm.
• Consumers should follow device instructions, seek pelvic‑floor assessment before weighted training, and get immediate medical attention for pain, bleeding or inability to retrieve a device.

Introduction

A short video or a shared X‑ray can turn a private mishap into a public safety lesson. That happened when 24‑year‑old Brazilian influencer Emelly Souza posted an image showing Kegel exercise balls lodged internally after a solo pompoarism session. The incident ended without surgical complications, thanks to prompt imaging and medical care, but it raises wider questions about how people use pelvic‑floor devices, what can go wrong and how to reduce risk.

Kegel balls and related weighted devices are marketed to women and people with vaginas to strengthen pelvic‑floor muscles, improve continence and enhance sexual sensation. They are inexpensive, widely available and often marketed online with little clinical oversight. That combination produces benefits for some users and hazards for others. The most common hazard is a retained device: an object intended to be inserted becomes difficult or impossible to remove without clinical assistance.

This article explains what happened in the Souza case, how Kegel balls work, why they can become lodged, what medical teams do to locate and extract retained devices, and clear practical guidance for safer use. The goal is practical: reduce embarrassment, remove speculation and give explicit steps to minimize harm.

What happened: the case of Emelly Souza

Emelly Souza, 24, from Joao Pessoa in Paraiba state, posted that she had been practicing pompoarism alone when the weighted balls she used became wedged internally and would not move as expected. After an unsuccessful attempt to remove them herself, she sought medical care. Clinicians used an X‑ray to determine the position of the balls and identify the safest removal strategy. The accessory was extracted without complications. Souza released the X‑ray image and urged followers to seek medical help rather than force removal attempts, emphasizing that “information is also a form of care.”

Two elements of this account are instructive. First, the decision to get an imaging study before trying blind extraction helped clinicians plan a measured approach and avoid causing injury. Second, the accessory appears to have been radiopaque — visible on X‑ray — which made localization straightforward. Not all devices show up on X‑ray; materials matter. Souza’s choice to seek professional help and publicize the outcome turns a personal incident into a prevention message.

Kegel balls, Ben Wa balls, and pompoarism: what the devices do and how people use them

Kegel balls — also called Ben Wa balls, vaginal weights or Ben Wa beads — are small, often spherical devices used to provide resistance for pelvic‑floor muscle training. Designs range from single weighted spheres with retrieval cords to pairs of connected beads and multi‑component units with internal moving weights meant to stimulate muscles during movement.

Pompoarism refers to a set of pelvic‑floor exercises, historically rooted in Southeast and South Asian traditions, which emphasize voluntary contraction, control and sometimes rhythmic or isolating movements of vaginal muscles. Modern fitness and sexual‑wellness markets have rebranded these techniques, sometimes adding weighted devices to intensify training.

Why people use these products:

• Improve urinary continence by strengthening muscles supporting the urethra and bladder base.
• Enhance sexual sensation and orgasmic control by increasing muscle tone and coordination.
• Aid postpartum recovery when used appropriately and with professional guidance.
• Add a component of pelvic‑floor “resistance training,” analogous to using weights for skeletal muscles.

Design and materials:

• Silicone (medical‑grade) is common for bodies; some models contain metal cores or small metallic weights that make them visible on X‑ray.
• Retrieval cords are standard on many designs; they provide a non‑medical, mechanical way to retrieve the device.
• Some beads are connected by a cord, others are linked by a flexible bridge or internal tether.

Not every product serves the same purpose. Some models are purely for sensation or pleasure, others are intended for progressive training with graduated weights. Users and clinicians must understand the device’s design before insertion.

Why Kegel balls and similar devices can become lodged

Vaginal anatomy and the mechanics of insertion and retention explain how a device intended to remain only briefly can become retained.

Anatomical factors:

• The vagina is a collapsible muscular tube that opens externally and extends up toward the cervix. Its depth and angle vary widely between individuals and with body position.
• Pelvic‑floor muscles (levator ani, pubococcygeus) surround the lower vagina and can contract strongly. When a device slips past the introitus, these muscles can sometimes hold it in place more firmly than expected.
• The cervix marks the upper limit of the vaginal canal; most devices cannot pass through the cervix into the uterus, but they can become lodged high in the vaginal fornices (spaces around the cervix).

Mechanical and user factors:

• Lack of a retrieval cord or an inadequate retrieval loop makes extraction difficult if a device migrates further into the vault.
• Smooth surfaces and small diameters allow the device to slip in but resist grip with fingers.
• Use during exercise or movement can shift a device into an awkward position.
• Using devices without prior pelvic‑floor assessment or without progressive training increases the chance of unanticipated retention.

Other risk contributors:

• Prior pelvic surgery, scarring or altered anatomy may change how a device behaves once inserted.
• Reduced pelvic‑floor awareness or limited manual dexterity can impair self‑retrieval.
• Purchasing unregulated products online increases the chance the device lacks safety features.

The Souza case illustrates this chain: a device intended for short training inadvertently travelled to a position that could not be safely reached without assistance.

How clinicians assess a retained pelvic‑floor device

Clinical assessment follows a simple principle: locate the device, evaluate for complications, and plan removal that minimizes trauma.

History and physical examination:

• Clinicians gather details: time since insertion, device type and materials, symptoms (pain, bleeding, discharge, fever), attempts at removal and any associated trauma.
• A gentle speculum or bimanual pelvic exam helps determine whether the object is low enough to grasp manually, whether the cervix is involved, and whether there are signs of infection or tissue injury.

Imaging:

• Plain radiography (X‑ray) is useful when the device contains metal or other radiopaque components. It shows the device’s position relative to pelvic bones and the bony pelvis.
• If the device is made of silicone without metallic elements, it may be invisible on X‑ray. Ultrasound is helpful in those cases. Transvaginal ultrasound offers detailed visualization of the pelvic vault and can show foreign bodies within the vagina.
• CT scanning is rarely required but can be used if there is concern about deeper tissue injury or uncertain localization when other imaging is inconclusive.

Why imaging matters:

• It confirms whether the device is within the vaginal canal or has somehow traversed into the cervix or uterus — the latter is extremely uncommon.
• It helps plan whether a bedside extraction will be safe or whether the patient requires anesthesia and a controlled operating‑room environment.
• Imaging can reveal associated problems such as retained fragments or abscess formation in prolonged cases.

In Souza’s situation, the X‑ray provided clear localization and allowed clinicians to proceed with extraction in a safe, measured manner.

Extraction techniques: from bedside retrieval to surgical removal

Most retained pelvic‑floor devices can be removed without surgery, but the method depends on location, size, patient comfort and presence of complications.

Bedside manual removal:

• For objects within reach, clinicians perform a speculum exam and may use lubricated gloved fingers to locate and gently pull out the device.
• Local anesthesia, topical numbing or a small procedure suite improves comfort and reduces reflex guarding.

Use of instruments:

• Grasping forceps or ring forceps allow the clinician to grasp a smooth object more securely than fingers alone.
• An appropriately sized speculum provides visualization; suction devices are sometimes used in specialized settings.
• In some cases, an instrument such as a tenaculum is unnecessary and would increase trauma.

When anesthesia is needed:

• If the object sits high in the vaginal vault, if the patient is unable to relax, or if prior attempts have failed, removal under sedation or general anesthesia gives better control and reduces the chance of accidental injury.
• Operating‑room removal is indicated when imaging suggests the device is inaccessible with simple tools or when a mucosal laceration or other complication requires repair.

Surgical intervention:

• True surgical extraction (transvaginal surgery under general anesthesia) is rarely required but used when an object is embedded or when removal risks significant tissue damage.
• In exceptional cases where a device has passed through the cervix — again, rare — a gynecologist may need to approach the uterus transvaginally.

Antibiotics and wound care:

• If removal is delayed or if there are signs of infection, clinicians may prescribe antibiotics and recommend follow‑up to ensure no retained fragments remain.
• Tetanus prophylaxis is considered only when the device is contaminated with soil or rust, which is uncommon with consumer pelvic‑floor devices.

The goal is gentle, complete removal with minimal trauma. Souza’s extraction was uncomplicated, but that outcome is contingent on clinician judgment and appropriate imaging.

Common complications and when they occur

A retained device almost always prompts anxiety and discomfort. Complications vary with time and degree of tissue contact.

Immediate complications:

• Pain and local discomfort.
• Superficial mucosal abrasions from attempts at removal.
• Vaginal bleeding if mucosa is abraded.

Short‑term complications:

• Bacterial vaginosis or other shifts in vaginal flora after a foreign body remains in place for several days.
• Localized infection with discharge, odor, fever and pelvic pain if the object is retained for multiple days.

Longer‑term or rare complications:

• Pressure necrosis of the vaginal mucosa with prolonged pressure in a fixed position.
• Fistula formation is exceedingly rare and typically associated with prolonged retention or additional risk factors.
• Systemic infection is uncommon but possible when removal is delayed and local infection spreads.

Perforation of the uterus or other internal organs as a result of a retained Kegel ball is extraordinarily rare because devices usually remain in the vaginal canal; such complications are more associated with invasive procedures or with devices that are structurally designed to penetrate.

Clinicians take time since insertion and symptoms seriously. Early evaluation reduces the risk of escalation.

Prevention: how to use Kegel balls and pelvic‑floor devices safely

Safer use begins before the device is purchased. Follow these practical steps.

Choose the right product:

• Prefer designs with a robust retrieval cord or a clearly visible retrieval loop. A secure loop reduces chance of lodging.
• Avoid smooth, very small objects without any retrieval mechanism.
• Where possible, choose medical‑grade silicone or other non‑porous, body‑safe materials. Steer clear of porous materials that trap bacteria.
• Check for visible, secure seams and a solid construction. If the unit contains metallic cores, be aware it will show on X‑ray — which is helpful if something goes wrong — but such devices may feel heavier and behave differently.

Read and follow instructions:

• Pay attention to recommended wear times. Many manufacturers advise short sessions rather than prolonged continuous wear.
• Use water‑based lubricant for insertion only when recommended. Some silicone devices pair poorly with silicone lubricants.
• Adhere to cleaning instructions: warm water and mild soap, or a manufacturer‑recommended cleaner; avoid boiling or harsh chemicals unless specified.

Start conservatively:

• Don’t begin with the heaviest weight. Start lighter and progress as pelvic‑floor strength improves.
• Consider supervised pelvic‑floor physiotherapy before starting weighted training, particularly if postpartum, post‑surgery, or if you have urinary symptoms.

Use common‑sense precautions:

• Never modify a device by removing a retrieval cord or reshaping it.
• Avoid devices with small detachable pieces that can separate.
• Don’t insert devices if you have active vaginal infection, abnormal bleeding or open wounds.

Recognize red flags during use:

• Sudden, intense pain, a sense that something has moved out of place, bleeding, or unusual discharge warrant immediate removal attempts or medical attention.
• If you cannot retrieve a device with gentle attempts, stop trying. Forcing or deep probing increases the chance of mucosal injury.

Battery‑powered or vibrating devices:

• Devices with batteries or electronic components introduce additional hazards if they malfunction. Use them for short periods and remove them promptly. If power failure or device disassembly occurs, seek care rather than attempting risky retrieval maneuvers.

These measures do not eliminate risk but reduce it substantially.

How to attempt safe self‑retrieval — and when to stop

If a device shifts or you suspect it is wedged, a few measured steps can help with safe self‑retrieval. The priority is to avoid harm.

Initial steps:

• Relax. Tension tightens the pelvic floor, making retrieval harder. Sit in a warm bath or soak in a tub for 10–15 minutes to encourage muscle relaxation.
• Assume a comfortable position where you can see and feel the introitus: squatting or sitting on the toilet can change the angle and bring the device lower.
• If a retrieval cord is visible, gently pull downward while breathing out and relaxing. Do not yank hard.

If the cord isn’t visible:

• Put on clean, lubricated gloves. Use a water‑based lubricant to ease fingertip passage.
• Insert the index and middle fingers with the pads facing upward and explore gently for the device. Use a hooking motion to catch a bead or loop.
• If you feel resistance, stop. Repeating forceful efforts increases mucosal injury risk.

When to stop and seek help:

• If you cannot find the device within a few minutes, if attempts are painful, or if there is bleeding or fever, seek medical attention promptly.
• Avoid using improvised tools (tweezers, hooks, hairpins). These can perforate tissue, break the device or push it higher.
• If the device contains electronics or is vibrating and cannot be turned off or removed, go to an urgent care center or emergency department.

The clinician’s goal is to remove the object safely. Souza’s decision to stop attempting self‑removal and seek care follows this guidance.

The role of imaging: when an X‑ray helps and when it does not

Imaging is an important diagnostic tool, but its usefulness depends on what the device is made from.

When X‑ray is useful:

• Devices with metallic components, metal cores or radiopaque additives appear clearly on plain radiographs. An X‑ray quickly shows location relative to pelvic bones and whether the object is within the vaginal canal.
• X‑ray is fast, widely available and inexpensive relative to CT or MRI.

When X‑ray is limited:

• Pure medical‑grade silicone, polypropylene and many plastics do not show up on X‑ray. In those instances, ultrasound is usually the next step.
• Ultrasound, including transvaginal ultrasound, visualizes soft tissues and can identify non‑radiopaque foreign bodies within the vagina and around the cervix.
• CT or MRI is reserved for complex cases or when deeper pelvic injury is suspected.

Choosing imaging should be driven by device composition, clinical findings and resource availability. Clinicians often ask the patient to bring the device’s packaging, a photo or the product itself for identification.

When to involve specialists: pelvic‑floor physiotherapists, gynecologists and emergency medicine

Different professionals play distinct roles.

Pelvic‑floor physiotherapists:

• Provide assessment before starting weighted training. They measure baseline strength, teach correct contraction and relaxation, and design progressive programs.
• Advise on device selection and techniques to avoid inadvertent retention.
• Help patients regain control and confidence after an extraction.

Emergency physicians and gynecologists:

• Manage acute retained devices. Emergency departments perform initial assessment, imaging and bedside extraction when safe.
• Gynecologists handle more complex cases requiring anesthesia, transvaginal surgical approaches or repair of mucosal injuries.
• Both specialties coordinate follow‑up care for infection prevention and monitoring.

Primary care and sexual‑health clinicians:

• Offer counseling on device use, hygiene and risk minimization.
• Provide referrals to physiotherapy or gynecology when indicated.

The ideal pathway is collaborative: physiotherapists prevent problems; emergency clinicians resolve acute events; gynecologists handle complications.

Product safety, labeling and the role of regulation

Kegel balls and personal wellness devices exist in a regulatory gray zone in many countries. They are often marketed as exercise tools rather than sex toys, which changes regulatory oversight.

Regulatory matters:

• In some jurisdictions, pelvic‑floor devices marketed for “medical” indications may undergo stricter scrutiny for materials and claims than those sold as lifestyle or sexual‑wellness products.
• Manufacturers may make claims about benefits without high‑quality clinical trials; consumers must evaluate marketing skeptically.
• Standards for body‑safe materials exist, but enforcement varies across marketplaces, especially online.

What consumers should check:

• Product material declarations: “medical‑grade silicone” is preferable; some products disclose specific polymers or certifications.
• Presence and strength of retrieval cords or loops.
• Manufacturer guidance on recommended use time, cleaning and contraindications.
• Customer reviews and credible third‑party testing, when available.

Clinicians and consumer advocates can push for clearer labeling: explicit warnings about retention risk, recommended maximum wear times, and instructions to consult a pelvic‑floor professional before weighted training would all help consumers make safer choices.

Practical guidance for clinicians advising patients

Clinicians need practical talking points when patients ask about pelvic‑floor devices.

Assessment before recommendation:

• Screen for urinary symptoms, pelvic pain, prior pelvic surgery, childbirth history and current infections.
• Consider a baseline pelvic‑floor assessment or referral to physiotherapy.

Patient education:

• Emphasize progressive training, starting with lighter weights and short sessions.
• Demonstrate insertion and retrieval techniques or refer to a physiotherapist who can.
• Insist on devices with clear retrieval mechanisms and durable construction.

Follow‑up:

• Advise patients to stop use immediately and seek care for pain, bleeding, fever or inability to retrieve a device.
• Document device type and instructions given if a patient later presents with a retained device.

These conversations lower the risk of incidents like the one Souza experienced.

Social and psychological aspects: embarrassment, disclosure and public education

Retained devices carry an understandable stigma. Many people delay seeking care because they fear judgment. Souza’s choice to publicize the X‑ray tackled stigma directly.

Addressing embarrassment:

• Healthcare providers should create a nonjudgmental environment. Clear, factual reassurance encourages early presentation.
• Public health messaging that balances safety information with respect for privacy drives earlier care‑seeking and reduces complications.

Value of public disclosure:

• Cases like Souza’s serve as teachable moments. When handled responsibly, they inform consumers about practical steps and reduce shame.
• Public education should focus on evidence‑based prevention: device selection, technique, progressive training and when to see a clinician.

Early help saves tissue and reduces the chance that a simple bedside extraction becomes a surgical case.

Practical checklist: what to do if a Kegel ball or pelvic device won’t come out

• Stop further forceful attempts after a couple of gentle tries. Avoid tools or household objects.
• Try relaxation methods: warm bath, deep breathing, squatting position to change angles.
• If a retrieval cord is present, pull gently while exhaling and relaxing.
• If you cannot retrieve the device within a short time, seek medical attention. Don’t wait until pain or infection develops.
• Bring the product packaging or the device itself to the clinic, if possible, to help clinicians with identification.
• Be honest with clinicians about the timeline and any prior attempts; this information informs the safest extraction approach.

Following this checklist improves outcomes and minimizes tissue trauma.

Broader context: pelvic‑floor health beyond devices

Devices are one tool within a broader approach to pelvic‑floor health. They are not a substitute for professional assessment or therapeutic exercise.

Alternative and complementary approaches:

• Pelvic‑floor physiotherapy teaches voluntary control, assesses for pelvic‑floor dysfunction (hypertonicity or overactivity), and tailors exercise programs that often start without weights.
• Biofeedback devices and clinic‑based training provide feedback on muscle contraction and relaxation without introducing a retained‑device risk.
• Lifestyle measures — weight management, smoking cessation, bladder training and constipation treatment — complement muscle training to reduce urinary symptoms.

Approach for postpartum and menopausal users:

• Postpartum bodies change rapidly. Wait times before beginning weighted internal exercises vary by clinician, but many recommend assessment before intensifying exercises after childbirth.
• Menopausal tissues may be thinner and more prone to irritation; clinicians often recommend topical estrogen therapy for atrophic vaginitis before starting internal weights, when indicated.

Devices can help, but they fit best within a professionally supervised regimen.

Lessons from the Souza case for consumers and clinicians

Three concrete lessons arise:

1. Seek help early. Souza stopped trying alone, obtained imaging and allowed clinicians to manage removal safely. Early presentation reduces the risk of infection and tissue injury.
2. Choose safer devices. Retrieval cords, solid construction and clear instructions reduce the chance of retention. Vendors and clinicians should push for better labeling.
3. Normalize the conversation. Public disclosure by a figure with social reach turned a private mishap into a prevention message. Clinicians should foster an environment where patients feel comfortable seeking prompt care.

The incident had a benign medical outcome. The public health value lies in converting a near‑miss into an opportunity to educate.

FAQ

Q: What exactly are Kegel balls and how do they differ from other pelvic‑floor devices? A: Kegel balls are small weighted spheres designed to provide resistance for pelvic‑floor muscles. Some are single spheres with a retrieval cord; others are linked beads. They differ from electronic pelvic‑floor trainers (which provide biofeedback) and from vibrating sex toys; their chief purpose is resistance training rather than stimulation, though marketing often blends the two.

Q: Are Kegel balls safe? A: They are safe for many users when chosen appropriately and used according to instructions. Safety depends on device design (retrieval mechanism, materials), user technique and awareness of contraindications. People with recent childbirth, active infection, pelvic pain disorders or uncertain pelvic‑floor function should consult a clinician before use.

Q: My Kegel ball slipped inside and I can’t feel it. What should I do right now? A: Stay calm. Sit in a warm bath and try to relax. If a retrieval cord is accessible, gently pull while exhaling and relaxing. If you can’t retrieve it within a short period, or if removal attempts are painful or cause bleeding, go to urgent care or an emergency department. Do not use household tools to attempt removal.

Q: Will the doctor judge me? A: Medical professionals are trained to treat retained devices without judgment. Prompt presentation improves outcomes. Clinicians routinely handle these cases and prioritize patient safety and privacy.

Q: Can a Kegel ball travel up into the uterus? A: It is highly unlikely for a Kegel ball to pass through the cervix into the uterus. Most retained devices remain within the vaginal canal, often in the upper vaginal vault around the cervix. Nevertheless, clinicians use imaging to confirm exact location.

Q: Will an X‑ray always show the device? A: No. X‑ray shows radiopaque materials like metal. Many silicone or plastic devices are radiolucent and invisible on plain radiographs. If the device is not seen on X‑ray, ultrasound typically provides visualization.

Q: Should I stop using Kegel balls after an episode of retention? A: Discuss with your clinician. If there were no lasting injuries and you understand the reasons for retention (such as device design or technique), you may resume with safer practices: choose a different device with a secure retrieval cord, seek physiotherapy guidance and begin with lighter training. If you have scarring, recurrent pelvic pain, or other complicating conditions, your clinician may recommend alternative approaches.

Q: How can I choose a safer product? A: Look for robust retrieval cords or visible loops, medical‑grade materials, clear cleaning instructions and credible manufacturer information. Avoid devices without a retrieval mechanism or with detachable parts. If in doubt, consult a pelvic‑floor physiotherapist.

Q: Are there regulations ensuring safety of these devices? A: Regulations vary by country and by how the product is marketed. Devices sold as medical tools may face higher scrutiny than those marketed as lifestyle or sexual‑wellness products. Consumers should evaluate labeling, materials and manufacturer transparency.

Q: How common are incidents like this? A: Retained intravaginal devices are uncommon relative to the number of users, but they are reported in clinical literature and media cases worldwide. Exact incidence is hard to determine because many cases resolve without medical care and not all are reported.

Q: What should clinicians ask when a patient presents with a retained device? A: Clinicians should take a focused history (time since insertion, device type, attempts at removal), perform a gentle pelvic exam, determine need for imaging and coordinate appropriate removal—either at bedside or under anesthesia. They should also screen for infection and counsel on prevention.

Q: Can pelvic‑floor physiotherapy prevent these incidents? A: Yes. A physiotherapist assesses baseline muscle strength and function, teaches proper technique, and recommends whether weighted devices are appropriate. They design progressive programs that reduce the risk of surprise retention.

Q: Is it dangerous to share X‑rays or images publicly like Souza did? A: Public disclosure is a personal choice. From a clinical perspective, sharing factual images with an educational intent can reduce stigma and promote safety messages. Patients should ensure privacy and avoid identifying details unless they choose otherwise.

Q: What are the signs of infection after a retained device? A: Increased pelvic pain, foul vaginal discharge, fever, chills, persistent bleeding or systemic symptoms. If any of these occur after a retained device or removal, seek medical care promptly.

Q: Any final practical tips? A: Buy responsibly, start light, use short sessions, keep the device clean, don’t modify it, and prioritize pelvic‑floor education. If something goes wrong, get help early.

The Souza case ended without surgical complication, but it underscores a routine truth: common consumer wellness devices can pose uncommon risks when used without adequate information or safety features. Clear product labeling, informed consumers and prompt medical access make these incidents preventable.