Vaginal Bleeding in Pre-pubertal Females

Ng, Sze May; Apperley, Louise; Upradrasta, Swathi

doi:10.1016/j.jpag.2020.01.152

Cited by 7 publications

(10 citation statements)

References 12 publications

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“…The management of vaginal bleeding in prepubertal children is usually left to the discretion of the clinician and has been reported to vary within and between institutions. [9][10][11] Going forward, larger prospective longitudinal studies would be useful to confirm the relevance and reliability of the red flags identified in this series to help target investigations and follow-up. The development of evidence-based clinical guidance for management would help to provide optimal and homogeneous care and to improve the outcomes for children presenting with vaginal bleeding.…”

Section: Discussionmentioning

confidence: 87%

“…In a case series of 17 prepubertal patients with vaginal bleeding, Ng et al . reported that all underwent a pelvic ultrasound, which had all normal findings 10 . However, they included only patients presenting with recurrent vaginal bleeding which may explain this high proportion of imaging.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 It had been suggested in the past that all prepubertal vaginal bleeding necessitated an examination under anaesthesia (EUA), 3 but this statement has been increasingly challenged. 2,4 Research on vaginal bleeding in prepubertal children is limited to case reports of unusual causes [5][6][7][8] and case series, of which only three are recent [9][10][11] while the rest were published several decades ago. 3,[12][13][14] Optimal management should aim at identifying conditions with a poor outcome or requiring a specific treatment, and avoiding over-investigating benign and self-resolving conditions.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…It had been suggested in the past that all prepubertal vaginal bleeding necessitated an examination under anaesthesia (EUA), 3 but this statement has been increasingly challenged 2,4 . Research on vaginal bleeding in prepubertal children is limited to case reports of unusual causes 5–8 and case series, of which only three are recent 9–11 while the rest were published several decades ago 3,12–14 …”

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confidence: 99%

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Vaginal bleeding in children: A retrospective audit at a tertiary paediatric gynaecology service

Drever

Peek

Moussaoui

et al. 2023

J Paediatrics Child Health

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Aim The aim of this study was to describe the clinical features and investigations of vaginal bleeding in prepubertal children. Methods We performed a retrospective case series of children under the age of 10 who presented with vaginal bleeding to our institution between 2018 and 2019. Results There were 32 cases identified during the timeframe, with a mean age of 5.5 years (standard deviation 3.2 years, range 5.5 days to 9.6 years). Vulvovaginitis was the most common diagnosis (n = 12, 37.5%), followed by precocious puberty (n = 5, 15.6%). Uncommon but serious causes were vaginal rhabdomyosarcoma (n = 1), and sexual abuse (one patient presenting with gonorrhoea and one with a non‐accidental injury). Vaginoscopy was performed in nine patients (28.1%) for various reasons, and a vaginal foreign body was identified in two patients (6.3%). All the patients who had a serious cause of bleeding (neoplasm or sexual assault) or who required specific treatment (precocious puberty, lichen sclerosus, urethral prolapse) presented with red flags on history and/or examination: recurrent episodes of vaginal bleeding, heavy bleeding, associated general symptoms (poor feeding and growth), presence of thelarche, abdominal mass, associated profuse vaginal discharge and abnormal genital examination (skin changes, urethral prolapse or protruding mass from the vagina). Conclusions A thorough history‐taking and clinical examination aiming at identifying red flags may help to discriminate between benign causes of vaginal bleeding, where no further investigations are indicated, and alternative diagnoses with a poor outcome and/or requiring specific treatment and additional investigations.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: What This Paper Addsmentioning

confidence: 99%

mentioning

confidence: 99%

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Vaginal bleeding in children: A retrospective audit at a tertiary paediatric gynaecology service

Drever

Peek

Moussaoui

et al. 2023

J Paediatrics Child Health

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“…I am eager to institute some of the elements of enhanced recovery after surgery that are described in this issue of the Journal of Pediatric and Adolescent Gynecology (JPAG). 4 Our patients are still experiencing the usual PAG concerns that are also addressed in this issue: symptomatic labial adhesions, 5 prepubertal vaginal bleeding, 6 chronic pelvic pain, 7 sexually transmitted infections, 8 issues related to contraception and induced abortion, 9e14 adnexal masses, 15,16 differences of sex development, 17 and M € ullerian anomalies, 18,19 among many other problems. The NASPAG Position Statement, published in this issue, highlights the ongoing reproductive health needs of adolescents during a pandemic, including the need for contraception and confidential healthcare, even when using telehealth platforms.…”

mentioning

confidence: 99%