PREMENARCHAL VAGINAL

BLEEDING

An  8-year-old  girl    is  brought by  her mother  to  the gynecologist’s  office

because of  vaginal bleeding    for two weeks.  The girl    states  that    she has not

taken   any medication  and gives   no  history suggestive  of  sexual  abuse.  She

does    not complain    of  headache    or  visual  disturbance and has been    doing

well    in  school. On  physical    examination she is  normal  for her age without

pubertal    changes,    and pelvic  examination under   sedation    reveals a   vaginal

foreign body.

Premenarchal bleeding is bleeding that occurs before menarche (the average age
at menarche is age 12). Possible causes include ingestion of estrogen medication,
a foreign body that irritates the vaginal lining, a cancer of the vagina or of the
cervix (sarcoma botryoides), a tumor of the pituitary or adrenal gland, an ovarian
tumor, sexual abuse, or idiopathic precocious puberty. The most common cause
of premenarchal bleeding is a foreign body.

Diagnosis and Management.

Pelvic  examination.    The patient who complains   of  premenarchal    bleeding

should  have    a   pelvic  examination under   sedation.   In  this    examination,

evidence    of  a   foreign body,   sexual  abuse,  or  tumor   is  looked  for.    Sarcoma

botryoides  typically   looks   like    grapes  arising from    the vaginal lining  or  from

the cervix.

Imaging study.  CT  scan    or  MRI scan    of  the pituitary,  abdomen,    and pelvis