Pre-Pubertal Vaginal Bleeding

Pre-Pubertal Vaginal Bleeding

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Summary

Vaginal bleeding after the first few weeks of life and before puberty is considered abnormal and warrants a visit to your child’s doctor. In newborn girls, withdrawal bleeding may occur as a normal response to maternal estrogen leaving the infant’s uterine lining.

Causes

After these first few weeks, vaginal bleeding in young girls can have a variety of causes, including:

  • Trauma - Straddle injuries, falls (like off a bicycle), or scratching leading to breaks in the skin are all potential causes of bleeding.
  • Foreign bodies – Toilet paper fragments are most common.
  • Vulvovaginitis – Infection and irritation caused by vaginal infections can cause bleeding on their own, or this could be caused by a scratch injury.
  • Hemangiomas – non-cancerous growths that form due to an abnormal buildup of blood vessels
  • Benign polyps or cysts or (rarely) cancerous tumors
  • Precocious puberty – associated with growth spurt, advanced bone age, breast and pubic hair development
  • Urethral prolapse – when inner lining of urethra sticks out, possibly due to trauma or straining
  • Sexual abuse
  • Pre-pubertal menarche – premature bleeding without other features of precocious puberty and without any other abnormal findings

Symptoms

Pre-pubertal bleeding is any bleeding that occurs before a girl has reached puberty. Though many causes of pre-pubertal bleeding are benign and/or self-limiting, it’s important to have your daughter checked out by a doctor.

Tests and Diagnosis

Your daughter’s doctor will first ask questions about when the bleeding started, how long it’s lasted, if your daughter suffered a fall or other injury before it started, and if there are associated symptoms like itching, pain, or odor.

The doctor will then perform a physical exam, including a pelvic exam if needed. Young children may need to be sedated or given a local anesthetic for this exam.

If your daughter’s doctor suspects precocious puberty, he or she will order blood tests to measure her hormone levels and an X-ray of her hand and wrist to assess bone age.

If the doctor suspects a hemangioma, cyst, polyp, or tumor is causing the bleeding, he or she may order an ultrasound of your daughter’s pelvis and abdomen.

Treatment

  • For normal newborn bleeding, no treatment is necessary.
  • For bleeding related to trauma, your daughter will likely heal on her own. Her doctor may prescribe warm or cold compresses and pain medication (if necessary) until she heals. If the doctor sees signs of sexual abuse, he or she will report that to you and the appropriate authorities.
  • If your daughter has vulvovaginitis caused by infection, she may be prescribed antibiotic or antifungal medication. If vulvovaginitis is caused by an irritant, the doctor will suggest avoiding harsh soaps, bubble baths, and detergents and wearing cotton underwear.
  • If bleeding is caused by a foreign body, the doctor can remove it during a pelvic exam. Sedation or anesthesia may be necessary.
  • If a cyst, tumor, polyp, or hemangioma is causing the bleeding – treatment depends on the size and type. Large, painful, or malignant growths may have to be surgically removed.
  • Urethral prolapse may not require treatment, or your daughter’s doctor may prescribe Vaseline, sitz bathes, or estrogen cream to speed healing. In rare cases, it needs to be corrected surgically.
  • If your daughter is diagnosed with precocious puberty, her doctor may prescribe hormone-blocking medications delivered through injections or implants.

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