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Vaginal bleeding in childhood


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Vaginal bleeding in childhood

  1. 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. 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. 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. 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. 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. 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. 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