Vaginal Bleeding in Prepubertal Girls: Etiology and Clinical Management

J Pediatr Adolesc Gynecol. 2016 Jun;29(3):280-5. doi: 10.1016/j.jpag.2015.10.017. Epub 2015 Oct 24.


Study 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%).

Conclusion: 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.

Keywords: Colposcopy; General anesthesia; Genital examination; Prepubertal vaginal bleeding; Young girls.

MeSH terms

  • Age Factors
  • Child
  • Child, Preschool
  • Disease Management*
  • Female
  • Granulosa Cell Tumor / complications
  • Gynecological Examination
  • Humans
  • Infant
  • Infant, Newborn
  • Neoplasm Recurrence, Local / complications
  • Retrospective Studies
  • Rhabdomyosarcoma / complications
  • Uterine Hemorrhage / diagnosis
  • Uterine Hemorrhage / etiology*
  • Vaginal Neoplasms / complications

Supplementary concepts

  • Granulosa cell tumor of the ovary