Ver el código de «Prepubertal vaginal bleeding»

==Background==
*Causes of [[vaginal bleeding]] in prepubescent children differ substantially from the causes in adolescents and adults

==Differential Diagnosis==
*Hormonal
**Neonatal hormonal withdrawal bleeding
***Maternal estrogen stimulates growth of fetus' endometrial lining
***After birth, estrogen wanes leading to an endometrial slough that results in a few days of bloody mucoid discharge or light vaginal bleeding
***Bleeding is self-limited and requires no treatment
**Exogenous estrogen
**Precocious puberty
***Bleeding out of synchrony with other signs of pubertal development or in a patient under the age of eight years warrants evaluation
**[[Hypothyroidism]]
*Nonhormonal
*[[Genitourinary trauma|Trauma]]
**Mechanisms include MVCs, straddle injuries, coitus
**Must consider [[sexual assault|sexual abuse]]
*Tumor
** Endodermal sinus tumors and rhabdomyosarcomas (including sarcoma botryoides)
**Present almost exclusively in girls under the age of three years with vaginal bleeding<ref>Fernandez-pineda I. Vaginal tumors in childhood: the experience of St. Jude Children's Research Hospital. J Pediatr Surg. 2011;46(11):2071-5.</ref>
** If no obvious cause of bleeding is found in the ED, refer to a pediatric gynecologist for a complete workup including vaginoscopy
*Urethral prolapse
*[[Condyloma acuminata|Genital warts]]
*[[Lichen sclerosus]]
**Chronic, mucocutaneous inflammatory disorder of unknown etiology
**May have purpura, telangiectasias, and hematomas
**Most common presenting symptoms are vulvar and perineal itching, soreness, and pain with defecation
*[[Vulvovaginitis]]
**Poor hygiene, nonspecific irritants
**Bacterial infections
***Most commonly group A beta-hemolytic streptococcus ([[Streptococcus pyogenes]])<ref> Stricker T. Vulvovaginitis in prepubertal girls. Arch Dis Child. 2003;88(4):324-326.</ref>
*[[Vaginal foreign body]]

==References==
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==See Also==
*[[Vaginal Bleeding (Main)]]

[[Category:OBGYN]]
[[Category:Pediatrics]]