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

Drever, Natalie, Peek, Sarah, Moussaoui, Dehlia, Dkeidek, Amira I., and Grover, Sonia R. (2023) Vaginal bleeding in children: A retrospective audit at a tertiary paediatric gynaecology service. Journal of Paediatrics and Child Health, 59 (4). pp. 653-659.

PDF (Published Version) - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (178kB) | Preview
View at Publisher Website:


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.

Item ID: 78544
Item Type: Article (Research - C1)
ISSN: 1440-1754
Keywords: precocious puberty, prepubertal vaginal bleeding, vulvovaginitis
Copyright Information: © 2023 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians). This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Date Deposited: 31 May 2023 02:23
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3215 Reproductive medicine > 321599 Reproductive medicine not elsewhere classified @ 0%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3215 Reproductive medicine > 321502 Obstetrics and gynaecology @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 100%
Downloads: Total: 113
Last 12 Months: 112
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page