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Prepubertal Vaginal Bleeding: Etiology, Diagnostic Approach, and Management

Howell, Jennifer O. MD; Flowers, Deborah MSN, CPNP

Obstetrical & Gynecological Survey: April 2016 - Volume 71 - Issue 4 - p 231–242
doi: 10.1097/OGX.0000000000000290
CME ARTICLES
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CME

Importance Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to parents. A variety of practitioners, including obstetrician-gynecologists and pediatricians, may be asked to see patients with this presenting complaint, yet many do not receive adequate training in pediatric gynecology.

Evidence Acquisition Review of the published literature in PubMed, focusing on the last 20 years, regarding the incidence, etiologies, diagnosis, and management strategies for the common causes of prepubertal vaginal bleeding.

Results Careful history taking and pediatric-specific gynecological examination skills, including awareness of normal anatomy across the age spectrum and the ability to identify an estrogenized hymen, are keys to the appropriate assessment of this clinical problem.

Conclusions and Relevance Prepubertal vaginal bleeding has many causes and requires a thorough targeted history and pediatric genitourinary examination, requiring knowledge of the variants of normal pediatric genitourinary anatomy. Most causes can be easily treated and are less likely to be due to sexual abuse or malignancy.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this activity, the learner will be better able to: Perform a symptom-focused pediatric genitourinary history and examination for the complaint of prepubertal vaginal bleeding, formulate a differential diagnosis for a pediatric patient with vaginal bleeding, and initiate treatment and management strategies for the common diagnoses that cause this complaint.

*Assistant Professor, Division of Women’s Primary Health, Department of Obstetrics and Gynecology, and Medical Evaluator, Beacon Child and Family Program, Department of Pediatrics, University of North Carolina; and †Program Coordinator/Nurse Consultant, NC Child Medical Evaluation Program, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Jennifer O. Howell, MD, Division of Women’s Primary Health, University of North Carolina, 3031 Old Clinic Bldg, Campus Box 7570, 101 Manning Dr, Chapel Hill, NC 27514. E-mail: johowell@med.unc.edu.

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