Genital bleeding in young girls who have not reached puberty

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Pediatric Gynecological problem 

Gynecological problems are not only experienced by adult,but also pediatric. Gynecological problems which can occur in kids which accounted for minimal percentage of pediatric surgery. These cases are mostly related to the female genital system but also stretch to cover conditions such as intersex conditions or ambiguous genitalia in which the genitals of the girl have the external appearance of female genital (phenotypic) with genotypically presence of Y chromosome and manifestation as males.




Some gynecological problems are;

Genital bleeding in young girls who have not reached puberty is a common complaint in pre-pubertal girls and is usually not serious but can cause anxiety in parents. In diagnosing this condition, attention is usually placed on past occurrences such as;

Douching or insertion of foreign bodies  : If she mistakenly inserted a instrument in the course of play. 

Sexual abuse and assault or defilement :This is increasing among young girls which can be perpetuated by friends, family or external family. Parents need to be careful when it comes to this. Nobody can be trusted here. Sitting on uncle laps should not be encouraged. 

pruritus : This is caused by exposure to pinworms, eczema, and insects bite. They cause serious Itching and scratching of the vagina which can break into the skin leading to bleeding. 

Urethral caruncle or prolapse :This is a common cause of blood stain in the young girls pants cause by the presence of a mass protruding from the urethra or obscuring the urethra. This may require surgery if there is no improvement after management with Amoxicillin and Metronidazole. 

Rectal bleeding : Often confused with vagina bleeding especially if anal fissures are not recognized and bleeding is noted in the pants or nappies. 




Withdrawal bleeding in neonates may occur soon after birth as a ‘withdraw bleed’  from maternal hormone. 

Precocious puberty will show signs of breast enlargement, pubic hair, advanced bone age and occasionally a mobile pelvic mass may be palpated . This mass may be an endocrine producing tumour of the ovary and will require laparoscopy and oophorectomy. 

Trauma :If there was an accident that had impact on the sex organ which will be found by examining the perineum to discover the extent of the injury. 

Medical history of the mother to rule out drug ingestion of diethylstilbestrol during pregnancy. 

Genital gynecological conditions can also be as a result of the presence of ovarian tumor which can be benign (teratomas) or malignant (teratomas, dysgerminomas, burkitt’s tumor. There can also be tumor in the uterine which can also be benign (hydrocortisone, bifid uterus) or malignant (sarcoma botyroides) or abnormalities of the vagina (simple cloaca, cloacal extrophy) or abnormalities of the external genitalia (clitoral  hypertrophy, fused labia, minor, ambiguous genitalia. Tumor in the vagina are rare. Sarcoma botyroides occurs in this location usually in girls less than 8years of age. Other conditions that can cause problems are ;abnormalities of the female genital tract and ambiguous genitalia (intersex conditions) . 

Risk Factors of  kids Gynaecological problem 




Mother exposure to certain drugs with affected diethylstilbestrol is noted to cause an increase in malignant tumours of the genital tract in their offspring. This is the popular  known cause of bleeding in kids. 



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