VAGINAL BLEEDING IN
Prof. M.C. Bansal.
MBBS., MS. MICOG., FICOG.
Founder Principal & controller Jhalwar Medical College and Hospital
Ex Principal & controller MahatmaGandhi Medical College & Hospital ,
Common Causes Of Vaginal Bleeding In Childhood
Foreign Body .
Trauma ---Sexual abuse / not related to sexual
Precocious Puberty .
Hemorrhagic cystitis ---Haematuria mistaken for
vaginal bleeding .
Bleeding Diathesis .
Exposure to Exogenous Sex Steroids .
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
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.
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 .
Bleeding Disorders Responsible
for Vaginal Bleeding in
Low Platelets ITP, leukaemia, aplastic
anaemia , Chemotherapy / other drug
induced bonemarrow suppression and
Platelet Dysfunction Clansman's
thrombasthenia .Bernard- Souler’s disease.
Clotting Disorders VonWillebrand’s
disease , Liver dysfunction .
Other causes ---Clinical
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
Capillary venous malformation of labia major has been
reported as a cause of vaginal bleeding in girls , tbe
differentiated from haemangimas . Malformations can be
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