Vaginal Bleeding

Vaginal bleeding in infants and prepubertal children requires evaluation. A complete history documenting the type, onset, and duration of vaginal bleeding with assessment for associated symptoms, including headache, visual complaints, abdominal pain or urinary issues, is required. Sexual abuse and trauma need to be considered. An examination should be performed, often under anesthesia, looking for marks of trauma; abnormalities in the genital exam include dermatologic conditions, structural abnormalities, and vaginal discharge; evidence of a foreign body; and/or presence of lesions. The goal of the exam is to establish and document the site of bleeding. Commonly, there is only undocumented bleeding with no obvious source. The differential diagnosis includes endocrine sources resulting in estrogen exposure.