Current review of prepubertal vaginal bleeding

Maggie Dwiggins, Veronica Gomez-Lobo

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


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.

Original languageEnglish
Pages (from-to)322-327
Number of pages6
JournalCurrent Opinion in Obstetrics and Gynecology
Issue number5
StatePublished - Oct 1 2017


  • genital examination
  • pediatric gynecologic malignancy
  • precocious puberty
  • prepubertal vaginal bleeding
  • sexual abuse
  • urethral prolapse
  • vulvovaginitis


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