Sexual Abuse as a Cause of Prepubertal Genital Bleeding: Understanding the Role of Routine Physical Examination

Julia Hadley, Jessica Moore, Amy Goldberg
Journal of Pediatric and Adolescent Gynecology 2021 January 19
Although accidental trauma is the most common mechanism for genital bleeding, sexual abuse should be considered when the patient is prepubertal and/or a vague history of bleeding is provided. Pre-pubertal female genital exams should be completed routinely; this clinical technique is critical for pediatricians to assess pubertal progression, to identify pathologies or differences in sexual differentiation, and to narrow a broad differential diagnosis of bleeding. Physical evidence of sexual abuse on exam is rarely found, and therefore the diagnosis relies on a child's disclosure. Physicians should be cognizant of barriers to patient disclosure. Our commentary aims to provide general pediatricians and trainees with a framework for evaluating genital/vaginal bleeding in prepubertal girls, by discussing the following: 1) the importance of a complete anogenital exam in generating a differential diagnosis; 2) the possibility of sexual abuse as an etiology with recognition that the disclosure process is complex.

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