Prepubertal vaginal bleeding


  • Causes of vaginal bleeding in prepubescent children differ substantially from the causes in adolescents and adults


  • 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
  • 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
  • Vaginal foreign body

Clinical Features

  • Vaginal bleeding
  • Prepubertal patient

Differential Diagnosis

Vaginal bleeding (main)






See Also

Vaginal bleeding (main)

External Links


  1. Fernandez-pineda I. Vaginal tumors in childhood: the experience of St. Jude Children's Research Hospital. J Pediatr Surg. 2011;46(11):2071-5.
  2. Stricker T. Vulvovaginitis in prepubertal girls. Arch Dis Child. 2003;88(4):324-326.