Etiological analysis of vaginal bleeding in girls

Abstract

Objective To investigate the etiological factors for abnormal vaginal bleeding in girls. Methods Data of 65 female children aged from 3 months and 10 years old with abnormal vaginal bleeding, who were treated in Department of Endocrinology, Wuhan Children's Hospital from March 2009 to October 2013 were collected by using medical records and follow-ups.By means of pelvic ultrasound, bone age assessment, hysteroscope, hormone level and genetic testing, the causes of the disease were analyzed. Results Of 65 patients, 37 cases had breast developed, 21 cases had nipple, areola and vulva pigmentation increased, 16 cases with genital secretions increasing and odor, the height growth in 21 cases accelerated, abdominal pain was presented in 5 cases, and 6 cases had skin milk coffee spots.The leading etiological factors for vaginal hemorrhage in these girls were sexual precocity.The peripheral precocious puberty accounted for the first place(30/65 cases, 46.2%), and followed by the central precocious puberty(20/65 cases, 30.8%). Hyperphlogosis accounted for 12.3%(8/65 cases), vaginal foreign body accounted for 6.2%(6/65 cases), and genital tract tumors accounted for 4.6%(3/65 cases). In the 30 peripheral precocious puberty cases, exogenous precocious puberty accounted for 16.9% (11 cases), 8 cases(12.3%) were of solitary ovarian cyst, 8 cases(12.3%) of McCune-Albright syndrome, and 3 cases of ovarian tumors.In the 20 central precocious puberty cases, idiopathic central precocious puberty accounted for 18.5%(12 cases), 4 cases(6.2%) were of organic disease of central nervous system, and 4 cases(6.2%) of hypothyroidism.Of 65 children, 12 cases lost follow-up and 1 case abandoned treatment.The rests received appropriate treatment according to different causes, and the vaginal bleeding were effectively controlled after 3 months to 2.5 years of follow-ups without recurrence of bleeding.But there were 2 cases of isolated ovarian cyst and 3 cases of McCune-Albright syndrome turned into central precocious puberty. Conclusions Endocrine diseases are the common factors for children's vaginal bleeding.Neoplasm is not rare in girl's abnormal vaginal hemorrhage. Key words: Uterine hemorrhage; Etiology; Puberty precocious; Child