Prepubertal vaginal bleeding: Difference between revisions
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==Background== | ==Background== | ||
*Causes of vaginal bleeding in prepubescent children differ substantially from the causes in adolescents and adults | *Causes of [[vaginal bleeding]] in prepubescent children differ substantially from the causes in adolescents and adults | ||
== | ===Causes=== | ||
*Hormonal | *Hormonal | ||
**Neonatal hormonal withdrawal bleeding | **Neonatal hormonal withdrawal bleeding | ||
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** If no obvious cause of bleeding is found in the ED, refer to a pediatric gynecologist for a complete workup including vaginoscopy | ** If no obvious cause of bleeding is found in the ED, refer to a pediatric gynecologist for a complete workup including vaginoscopy | ||
*Urethral prolapse | *Urethral prolapse | ||
*Genital warts | *[[Condyloma acuminata|Genital warts]] | ||
*[[Lichen sclerosus]] | *[[Lichen sclerosus]] | ||
**Chronic, mucocutaneous inflammatory disorder of unknown etiology | **Chronic, mucocutaneous inflammatory disorder of unknown etiology | ||
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**Poor hygiene, nonspecific irritants | **Poor hygiene, nonspecific irritants | ||
**Bacterial infections | **Bacterial infections | ||
***Most commonly group A beta-hemolytic streptococcus (Streptococcus pyogenes)<ref> Stricker T. Vulvovaginitis in prepubertal girls. Arch Dis Child. 2003;88(4):324-326.</ref> | ***Most commonly group A beta-hemolytic streptococcus ([[Streptococcus pyogenes]])<ref> Stricker T. Vulvovaginitis in prepubertal girls. Arch Dis Child. 2003;88(4):324-326.</ref> | ||
* | *[[Vaginal foreign body]] | ||
==Clinical Features== | |||
*Vaginal bleeding | |||
*Prepubertal patient | |||
==Differential Diagnosis== | |||
{{DDX undifferentiated VB}} | |||
==Evaluation== | |||
===Workup=== | |||
===Diagnosis=== | |||
==Management== | |||
==Disposition== | |||
==See Also== | |||
{{DDX undifferentiated VB}} | |||
==External Links== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:OBGYN]] | [[Category:OBGYN]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
Latest revision as of 18:30, 12 January 2021
Background
- Causes of vaginal bleeding in prepubescent children differ substantially from the causes in adolescents and adults
Causes
- Hormonal
- Neonatal hormonal withdrawal bleeding
- Maternal estrogen stimulates growth of fetus' endometrial lining
- After birth, estrogen wanes leading to an endometrial slough that results in a few days of bloody mucoid discharge or light vaginal bleeding
- Bleeding is self-limited and requires no treatment
- Exogenous estrogen
- Precocious puberty
- Bleeding out of synchrony with other signs of pubertal development or in a patient under the age of eight years warrants evaluation
- Hypothyroidism
- Neonatal hormonal withdrawal bleeding
- Nonhormonal
- Trauma
- Mechanisms include MVCs, straddle injuries, coitus
- Must consider sexual abuse
- Tumor
- Endodermal sinus tumors and rhabdomyosarcomas (including sarcoma botryoides)
- Present almost exclusively in girls under the age of three years with vaginal bleeding[1]
- If no obvious cause of bleeding is found in the ED, refer to a pediatric gynecologist for a complete workup including vaginoscopy
- Urethral prolapse
- Genital warts
- Lichen sclerosus
- Chronic, mucocutaneous inflammatory disorder of unknown etiology
- May have purpura, telangiectasias, and hematomas
- Most common presenting symptoms are vulvar and perineal itching, soreness, and pain with defecation
- Vulvovaginitis
- Poor hygiene, nonspecific irritants
- Bacterial infections
- Most commonly group A beta-hemolytic streptococcus (Streptococcus pyogenes)[2]
- Vaginal foreign body
Clinical Features
- Vaginal bleeding
- Prepubertal patient