Vaginal Bleeding in Prepubertal Girls: Etiology and Clinical Management.
OBJECTIVE
We aimed to investigate the etiology and clinical management of vaginal bleeding in girls aged 0-9 years and to compare our results with previous publications. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The records of all girls younger than 10 years of age who were seen between 2001 and 2011 at Skåne University Hospital Lund for vaginal bleeding were retrospectively collected.


RESULTS
We identified 86 girls with vaginal bleeding. Of those, 47 (54.7%) were diagnosed with a local lesion, the etiology was hormonal in 16 (18.6%), and in 23 (26.7%) the etiology was unclear. Trauma was the most frequent cause of local lesions and hormonal withdrawal of the newborn was the most common hormonal etiology. Two girls were diagnosed with a tumor, 1 with relapse of a vaginal rhabdomyosarcoma, and the other with recurrence of an ovarian granulosa cell tumor. There were large disparities in the clinical management of vaginal bleeding. A genital examination was conducted in 70 of 86 (81.4%), and colposcopy in only 8 of 86 of the patients (9.3%).


CONCLUSIONS
This study confirmed vaginal bleeding as a rare finding in girls younger than 10 years of age. It is usually a benign symptom, but because there might be a serious underlying condition, proper investigation and follow-up are needed. Clinical management varied in our patient cohort. This might be because of insufficient knowledge and might indicate the need for general guidelines.
Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden.
Hanna Fiscella
HF
Söderström
Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden.
Annelie
A
Carlsson
Department of Clinical Sciences, Pediatric Surgery, Skåne University Hospital Lund, Lund University, Lund, Sweden.
Anna
A
Börjesson
Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden. Electronic address: maria.elfving@med.lu.se.
Maria
M
Elfving
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006106:Granulosa Cell Tumor / Q000150:complications; D058869:Gynecological Examination; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009364:Neoplasm Recurrence, Local / Q000150:complications; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000150:complications; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D014625:Vaginal Neoplasms / Q000150:complications
Colposcopy; General anesthesia; Genital examination; Prepubertal vaginal bleeding; Young girls