Current review of prepubertal vaginal bleeding.

MedStar author(s):
Citation: Current Opinion in Obstetrics & Gynecology. 29(5):322-327, 2017 OctPMID: 28858895Institution: MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology/Pediatric and AdolescentForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2017Local holdings: Available online from MWHC library: February 1998 - presentISSN:
  • 1040-872X
Name of journal: Current opinion in obstetrics & gynecologyAbstract: 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.All authors: Dwiggins M, Gomez-Lobo VFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-09-18
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28858895 Available 28858895

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.

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