Some Causes of Vaginal Bleeding in Infants and Children
Cause | Common Features* | Diagnostic Approach |
|---|---|---|
During infancy | ||
Exposure to the mother's estrogen before birth | A small amount of bleeding during the first 1–2 weeks of life | A doctor's evaluation |
During childhood | ||
A foreign object in the vagina | Usually a foul-smelling discharge, often containing small amounts of blood Sometimes a history of having inserted an object into the vagina | A doctor's evaluation Sometimes a pelvic examination after the girl is sedated or given a general anesthetic |
Development of breasts and appearance of pubic and underarm hair (as occurs during puberty) at a young age | A doctor's evaluation X-rays of the hand and wrist to check for speeded-up growth of bones Blood tests to measure hormone levels | |
Physical trauma (including sexual abuse) | Recent history of a fall or other possible cause of injury to the vaginal area Difficulty walking or sitting and/or bruises or tears around the genitals, anus, or mouth Vaginal discharge or redness | A doctor's evaluation |
Prolapse (protrusion) of the lining of the urethra) | Small amount vaginal bleeding or blood on toilet paper or in toilet after urination Sometimes pain with urination | A doctor's evaluation Urine culture (to evaluate for urinary tract infection) |
Dermatitis (allergic reaction or irritation of the vagina or genital area caused by chemicals) | Sometimes vaginal or vulvar bleeding Vaginal or vulvar redness and/or swelling Sometimes vaginal or vulvar itching or vaginal discharge | A doctor's evaluation Identifying products (such as toilet paper, soaps, bubble bath, laundry detergent) that come into contact with the genital area that may be the cause and stopping their use |
White patches on the vulva Vulvar itching | Usually a doctor's evaluation alone Sometimes a biopsy | |
Gynecologic cancer (rare in children) | A mass visible at the opening of the vagina Persistent abdominal pain or swelling | A doctor's evaluation Sometimes an ultrasound of the pelvic area and abdomen |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||