title: Prepubertal Vaginal Bleeding: Etiology, Diagnostic Approach, and Management.
abstract: OBJECTIVE
  Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to parents. A variety of practitioners, including obstetrician-gynecologists and pediatricians, may be asked to see patients with this presenting complaint, yet many do not receive adequate training in pediatric gynecology.
  
  
  METHODS
  Review of the published literature in PubMed, focusing on the last 20 years, regarding the incidence, etiologies, diagnosis, and management strategies for the common causes of prepubertal vaginal bleeding.
  
  
  RESULTS
  Careful history taking and pediatric-specific gynecological examination skills, including awareness of normal anatomy across the age spectrum and the ability to identify an estrogenized hymen, are keys to the appropriate assessment of this clinical problem.
  
  
  CONCLUSIONS
  Prepubertal vaginal bleeding has many causes and requires a thorough targeted history and pediatric genitourinary examination, requiring knowledge of the variants of normal pediatric genitourinary anatomy. Most causes can be easily treated and are less likely to be due to sexual abuse or malignancy.
authors.affiliation: Assistant Professor, Division of Women's Primary Health, Department of Obstetrics and Gynecology, and Medical Evaluator, Beacon Child and Family Program, Department of Pediatrics, University of North Carolina.
authors.forename: Jennifer O
authors.initials: JO
authors.lastname: Howell
authors.affiliation: Program Coordinator/Nurse Consultant, NC Child Medical Evaluation Program, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Deborah
authors.initials: D
authors.lastname: Flowers
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D058869:Gynecological Examination; D006801:Humans; D007223:Infant; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy