Current review of prepubertal vaginal bleeding.
Current review of prepubertal vaginal bleeding.
- 2017
Available online from MWHC library: February 1998 - present
PURPOSE OF REVIEW: Prepubertal vaginal bleeding raises many concerns and evaluation and diagnosis may prove difficult for many providers. We aim to provide a comprehensive review and recent updates for those practitioners who care for these patients. RECENT FINDINGS: Prompt management in the case of prepubertal vaginal bleeding is indicated, especially to rule out malignancy or abuse. If a child is reluctant to undergo examination, or if the extent of injury or source of bleeding cannot be determined, examination under anesthesia and vaginoscopy is recommended. Use of vaginoscopy allows for clear visualization of the vagina and cervix without distorting hymenal anatomy, as well as diagnosis and removal of a foreign body and evaluation of mucosal damage caused. In the case of sexual abuse, providers specifically trained in pediatrics need to be present, and safety of the patient should always be ensured. SUMMARY: Careful history taking and targeted examination may lead to diagnosis in the case of prepubertal vaginal bleeding. However, in more difficult cases, practitioners should not hesitate to examine a patient in the operating room using general anesthesia to elicit the cause. Although sexual abuse and malignancy are always on the differential, most causes of bleeding are benign and easily treated.
English
1040-872X
*Genital Neoplasms, Female/co [Complications]
*Uterine Hemorrhage/et [Etiology]
*Vulvovaginitis/co [Complications]
*Wounds and Injuries/co [Complications]
Child
Child Abuse, Sexual/di [Diagnosis]
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Medical History Taking
Physical Examination
Puberty
Puberty, Precocious/co [Complications]
Skin Diseases/co [Complications]
Urethral Diseases/co [Complications]
MedStar Washington Hospital Center
Obstetrics and Gynecology/Pediatric and Adolescent
Journal Article
Available online from MWHC library: February 1998 - present
PURPOSE OF REVIEW: Prepubertal vaginal bleeding raises many concerns and evaluation and diagnosis may prove difficult for many providers. We aim to provide a comprehensive review and recent updates for those practitioners who care for these patients. RECENT FINDINGS: Prompt management in the case of prepubertal vaginal bleeding is indicated, especially to rule out malignancy or abuse. If a child is reluctant to undergo examination, or if the extent of injury or source of bleeding cannot be determined, examination under anesthesia and vaginoscopy is recommended. Use of vaginoscopy allows for clear visualization of the vagina and cervix without distorting hymenal anatomy, as well as diagnosis and removal of a foreign body and evaluation of mucosal damage caused. In the case of sexual abuse, providers specifically trained in pediatrics need to be present, and safety of the patient should always be ensured. SUMMARY: Careful history taking and targeted examination may lead to diagnosis in the case of prepubertal vaginal bleeding. However, in more difficult cases, practitioners should not hesitate to examine a patient in the operating room using general anesthesia to elicit the cause. Although sexual abuse and malignancy are always on the differential, most causes of bleeding are benign and easily treated.
English
1040-872X
*Genital Neoplasms, Female/co [Complications]
*Uterine Hemorrhage/et [Etiology]
*Vulvovaginitis/co [Complications]
*Wounds and Injuries/co [Complications]
Child
Child Abuse, Sexual/di [Diagnosis]
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Medical History Taking
Physical Examination
Puberty
Puberty, Precocious/co [Complications]
Skin Diseases/co [Complications]
Urethral Diseases/co [Complications]
MedStar Washington Hospital Center
Obstetrics and Gynecology/Pediatric and Adolescent
Journal Article