Vaginal bleeding in the pre-pubertal child

Vaginal bleeding is a rare presenting complaint in pre-pubertal girls which can cause a lot of anxiety in parents and carers. The differential diagnoses range from relatively simple conditions such as vulvovaginitis to more sinister conditions including malignant vulval tumours or child sex abuse. A detailed clinical review is required in making a diagnosis and planning treatment. This review article will provide an overview of the most likely differential diagnosis and suggests an approach to assessment and management for the general paediatrician.