Causes of vaginal bleeding in children and adolescents

At any time

Trauma (blunt or penetrating*)

Tumor (benign or malignant*)

Before normal menarche

Hormonal

Neonatal hormonal withdrawal bleeding

Exogenous estrogen

Precocious puberty

Nonhormonal

Urethral prolapse

Genital warts

Lichen sclerosus

Infectious vaginitis

Foreign body

After menarche

Pregnancy^¶

Ectopic pregnancy*

Spontaneous abortion

Placenta previa*

Abruptio placentae*

Abnormal uterine bleeding (most common conditions in adolescents: delayed pubertal maturation, polycystic ovary syndrome, or caused by hormonal contraception)^Δ

Pelvic infection

Bleeding disorder (especially platelet dysfunction, von Willebrand disease, or factor deficiency)

*Life-threatening condition.
¶ Refer to UpToDate topics on vaginal bleeding during pregnancy.
Δ Refer to UpToDate topics on abnormal uterine bleeding in the adolescent.

Reproduced with permission from: Paradise JE. Vaginal bleeding. In: Textbook of Pediatric Emergency Medicine, 6th ed, Fleisher GR, Ludwig S (Eds), Lippincott Williams & Wilkins, Philadelphia, 2010. Copyright © 2010 Lippincott Williams & Wilkins. www.lww.com.

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Causes of vaginal bleeding in children and adolescents