Evaluation of vaginal bleeding in the preadolescent child

Vaginal bleeding in a prepubertal child is always a serious medical concern. Vaginal bleeding in this age group may result from estrogen stimulation, which is more likely to be pathological than physiological, infections, tumors of the lower genital tract, ovarian tumors, foreign bodies, or trauma. Evaluation and management of the prepubertal child requires an understanding of the techniques of the physical examination, comprehension of the normal prepubertal unestrogenized anatomy, and indications for a more comprehensive examination under anesthesia. Caution should be exercised by the clinician so that the physical examination and workup do not further traumatize the child.