Pre-pubertal vaginal bleeding

What are the signs and symptoms of pre-pubertal vaginal bleeding?

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

How is pre-pubertal vaginal bleeding diagnosed?

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, which may include checking for any breast or pubic hair growth.  Young children may need to be sedated or given a local anesthetic for this exam.

If your daughter’s doctor suspects precocious puberty, they will order blood tests to measure the 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.

What are the causes of pre-pubertal vaginal bleeding?

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

• Trauma - straddle injuries
• Foreign bodies (Toilet paper fragments are most common)
• Vulvovaginitis
• Hemangiomas
• Benign polyps or cysts or (rarely) cancerous tumors
• Precocious puberty 
• Urethral prolapse
• Sexual abuse
• Pre-pubertal menarche 

How is pre-pubertal vaginal bleeding treated?

It is important to have your daughter checked out by a pediatric gynecologist.

• Newborns - For normal newborn bleeding, no treatment is necessary.
• Trauma - 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.
• Vulvovaginitis - 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.
• Foreign body - If bleeding is caused by a foreign body, the doctor can remove it during a physical exam. Sedation or anesthesia may be necessary.
• Cyst, tumor, polyp, or hemangioma - If a cyst, tumor, polyp, or hemangioma is causing the bleeding – treatment depends on the size and type. Large, painful, or malignant growths will have to be surgically removed.
• Urethral prolapse - Urethral prolapse may not require treatment, or your daughter’s doctor may prescribe Vaseline®, sitz bathes, and estrogen cream to speed healing. In rare cases, it needs to be corrected surgically.
• Precocious puberty - If your daughter is diagnosed with precocious puberty, her doctor may prescribe hormone-blocking medications delivered through injections or implants.