BLEEDING IN PREPUBERTY (Part Two)

DIAGNOSIS

1 - Examination

We make a casual observation of the external side and the distal vagina for any visible lesion or trauma.

In the absence of any apparent cause on the external side and in the distal vagina, an examination with anesthesia is performed, using vaginoscopy by a gynecologist with pediatric experience to evaluate the vagina and cervix.

2 - Imaging

a - Transabdominal pelvic ultrasound

Evaluates:

• The uterus (size, dimensions, and any possible lesion). At this age, the size of the uterus and cervix is the same. Approximately the dimensions of the uterus are: length 2 - 3.5 cm and width 0.5 - 1 cm.
• The ovaries (evaluates the size, dimensions, follicular development, and any possible lesion or cyst).

b - MRI

Evaluates the uterus, ovaries, their characteristics, and any possible lesion in them and the surrounding organs, without exposing the child to radiation.

c - CT

Evaluates the uterus, ovaries, their characteristics, and any possible lesion in them and the surrounding organs.

3-Laboratory examination

It gives us the opportunity to evaluate the general condition of the child and guides us towards different pathologies. From the bleeding, the child may develop anemia, therefore, a complete blood evaluation with morphology (Hb, Ht, erythrocytes, platelets, and leukocytes) is necessary.

A general condition assessment is made as a cause for bleeding could also be liver, renal, hematological pathologies (azotemia, creatinine, SGOT, SGPT, bilirubin, coagulation profile...)

Vaginal secretions are evaluated and cultured (antibiogram and mycogram)

Classification of genital findings

1. Normal (normal appearance of the genital pathways)
2. Non-specific findings (suspected abuse)
3. Findings for abuse and trauma
4. Penetrative trauma, clear force