Infantile hemangiomas (IH) are the most common soft tissue tumors of infants and children which characteristically spontaneously resolve by 7-10 years of age. IH generally require no intervention, but rarely can cause disfiguration, functional impairment, bleeding or infection. Here we present a unique case of cervical infantile hemangioma in a 6 yo who presented with vaginal bleeding requiring transfusion. Patient is a 6 year 10 month-old female with history of unexplained intermittent vaginal bleeding since 6 months of age. On current presentation, she presented to an outside hospital with acute vaginal bleeding, accompanied by a 5 unit drop in Hgb over 24 hours, requiring transfusion. Previous evaluation by Pediatric and Adolescent Gynecology service at 28 months with vaginoscopy revealed normal anatomy but evidence of vaginitis and cervicitis, which was treated with topical estrogen. She was subsequently followed by pediatric endocrinology, with findings of no evidence of precocious puberty, and labs consistent with prepubertal state. Upon presentation to the outside hospital requiring transfusion, she had a normal pelvic ultrasound showing a prepubertal uterus and ovaries. She was transferred to our medical center for ongoing management where she underwent an urgent exam under anesthesia and repeat vaginoscopy which revealed a <1 cm cervical raised papule that was biopsied. Hemostasis was achieved with vaginal packing which was uneventfully removed POD 1. Pathology was consistent with infantile capillary hemangioma, with capillary vascular proliferation and positive staining for GLUT-1. Follow up MRI with contrast did not show evidence of a vascular lesion or pelvic mass. The differential diagnoses for vaginal bleeding in the prepubertal child include vaginal foreign body, trauma, neoplasm, precocious puberty, and vascular malformations. Only a single case report of infantile hemangioma of the cervix has previously been reported in the literature. In non-cutaneous cases, diagnosis must rely on imaging and pathology. MRI is used to delineate the location and extent of IH, and differentiate it from other high-flow vascular lesions such as arteriovenous malformations. In this case, however, the lesion could not be appreciated on imaging, likely due to its small size. Pathological assessment was crucial to our diagnosis. The cervical biopsies taken at time of vaginoscopy demonstrated capillary vascular proliferation, GLUT-1 and WT-1 positivity, but PROX-1 negativity. GLUT-1 is a sensitive and specific marker for both proliferating and involuting IH. It is not found in other vascular neoplasms or malformations. Profuse bleeding is a rare complication of IH and has been most noted in the hemangiomas of the GI tract. IH in GI system can be treated with medication corticosteroids with or without propranolol, or may require surgical resection. Follow up treatment for this patient will consist of a 6 month trial of propranolol with repeat vaginoscopy and possible excision. In the future, physicians should consider infantile hemangioma of the vagina or cervix as part of the differential diagnosis in patients presenting with prepubertal bleeding.