UMEM Educational Pearls

  • comprehensive history and thorough external genital exam (often without direct visualization of the cervix) will lead to appropriate diagnosis
  • estrogen withdrawal following birth or ingestion of oral contraceptives
  • vaginal foreign bodies (such as toilet paper, small toys)
  • bacterial infections (strep and shigella)
  • trauma from sexual abuse or straddle injuries
  • vascular lesions such as hemangiomas
  • be careful to differentiate urethral bleeding from vaginal bleeding

References

Emans SJ, Laufer MR, Goldstein DP. Vulvovaginal problems in teh prepubertal child. In: Pediatric and Adolescent Gynecology. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1998:75-107