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Fifteen-minute consultation: Apparent vaginal bleeding in the pre-pubertal girl
  1. Julie-Ann Collins1,
  2. Julie-Ann Maney1,
  3. Alison Livingstone2,3
  1. 1 Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2 Community Paediatrics, Northern Health and Social Care Trust, Antrim, UK
  3. 3 The Rowan SARC, Antrim Area Hospital, Antrim, UK
  1. Correspondence to Dr Julie-Ann Collins, Emergency Department, Royal Belfast Hospital for Sick Children, Belfast BT12 6BE, UK; jacollins{at}


A parent or carer’s observation of blood in a child’s nappy or underwear can be quite alarming for both parent and child and may indicate vaginal bleeding. At first glance, it may be difficult to ascertain whether the bleeding is from the skin, genital tract, urinary tract or anus. Confirmed vaginal bleeding in a pre-pubertal girl is rare but always abnormal and requires comprehensive assessment to determine the cause. Recognition of normal female pre-pubertal anatomy is essential to detect any abnormalities. Appropriate action should be taken according to findings on initial inspection of the ano-genital area. The possibility of child sexual abuse and the need for specialist paediatric sexual offences medicine examination by an FME (Forensic Medical Examiner) or specialist paediatrician should always be considered. This article offers a systematic approach to assessment in pre-pubertal girls with apparent vaginal bleeding which will benefit general paediatricians, emergency department practitioners and GPs.

  • vaginal bleeding
  • pre-pubertal child

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  • Twitter @julieannmaney

  • Contributors J-AC researched and wrote the article. It was reviewed and edited by J-AM and AL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.