Urethral prolapse: An important differential diagnosis of bleeding from the vulva in pre-pubertal African girls

Abstract

Urethral prolapse is the abnormal protrusion of the urethral mucosa through the external urethral meatus. It is a rarely diagnosed condition as most cases will be misdiagnosed as sexual abuse. If diagnosed, however, medical treatment with follow-up will usually suffice. If this fails, or in the presence of complications, surgical management may be employed. The most common presenting feature is urogenital bleeding. Genital bleeding in a pre-pubertal child is alarming to parents. Their first impression is that of a sexual abuse resulting in the suspicion of all adult males in the surrounding environment. The condition is worsened by a scenario in which the child is either too little to give an account or where she points accusing fingers to some adults. We report a case of bleeding from the vulva from urethral prolapse masquerading as suspected sexual abuse from an unknown adult.