1. VAGINAL BLEEDING IN
CHILDHOOD
Prof. M.C. Bansal.
MBBS., MS. MICOG., FICOG.
Founder Principal & controller Jhalwar Medical College and Hospital
Jhalawar.
Ex Principal & controller MahatmaGandhi Medical College & Hospital ,
Sitapura, Jaipur.

2. Common Causes Of Vaginal Bleeding In Childhood
 Foreign Body .
 Vulvovaginitis .
 Trauma ---Sexual abuse / not related to sexual
abuse .
 Precocious Puberty .
 Hemorrhagic cystitis ---Haematuria mistaken for
vaginal bleeding .
 Bleeding Diathesis .
 Neoplasm.Urethal prolapse.
 Exposure to Exogenous Sex Steroids .

3. Clinical Presentation
 A Foreign body is commonest cause of vaginal bleeding in
Pediatric patients, pertcularly when foul smell is also present .
USG and local examination under GA . Flushing vagina with
antiseptic solution with pressure will flush out the foreign body/
removed with small curved artery clamp . start Oral antibiotic
andT.T toxoid therapy.
 Vulvo vaginits ---often due to poor hygiene –antibiotic -anti
fungal ointment
 Traumatic bleeding is often accidental ,but sexual assault
should always be kept in mind . Blunt injury lead to vulvar
hematoma while penetrating injury warrant care full
examination under GA and appropriate suturing , antibiotic,
anti tetanus therapy must be given .
 When sexual assault is suspected other agencies like police,
hospital administration and social services, expert from
Forensic department should be summoned immediately.

4. Clinical Presentation------
It could be the first manifestation of precocious
puberty. thorough clinical evaluation , investigation
and proper treatment along with health and sex
education should be given
.
Hemorrhagic Cystitis ---Adenovirus infection or drug
toxicity ( cyclophpsphamide) are two common
causes. Girl presents with dysurea , sterile
haematuria and urgency.Viral infection is self
limiting but in drug induced case , drug with drawl
will solve the problem .

5. Bleeding Disorders Responsible
for Vaginal Bleeding in
Childhood
 Low Platelets  ITP, leukaemia, aplastic
anaemia , Chemotherapy / other drug
induced bonemarrow suppression and
Hypersplenism .
 Platelet Dysfunction  Clansman's
thrombasthenia .Bernard- Souler’s disease.
 Clotting Disorders VonWillebrand’s
disease , Liver dysfunction .

6. Other causes ---Clinical
picture
 Urethral Prolapse , uncommon is characterized by protrusion of
urethral mucosa all around the external meatus and forming a
hemorrhagic vulvar mass. It responds to topical estrogen.
 Benign and Malignant tumors of vulva may present as vaginal
bleeding . Sarcoma botryoides is a vaginal carcinoma that
occurs primarily in girls of 2years age (90%) .Mesonephric
carcinoma usually affects girls >3 years of age , Clear cell
carcinoma and vaginal adenosis are often related to intra
uterine exposure to stilbestrol –refer them to pediatric
oncologist.
 Capillary venous malformation of labia major has been
reported as a cause of vaginal bleeding in girls , tbe
differentiated from haemangimas . Malformations can be
rxcised

7. For Further Reading ---
 Minjarez DA .Abnormal bleeding in adolescents .
Semin report Med; 21: 363-3.
 Sanfilppo JS . Gynaecological problems of
childhood . In : Behrman RE , Kliegman R,
JensonWE.eds. NelsonText Book of Pediatrics ,
16th Edn Philadelphia: WB Sauders, 200:1663-4