This is Esmeralda's donut pillow. There are no noticeable stains or scratches, but it has been used, so please be aware of minor details. One child used it with a gauze or towel placed on it. It was used by rotating three pillows, so I think it's relatively clean. The insert is not included, only the pillow. However, this one was purchased a little later after I started using other ones, so it's in slightly better condition, and I'm offering it at the same price. If I find the insert before shipping, I will include it. The paper that came with the product is not included because it is not in very good condition.