Study Objective

Puberty is a normal process for adolescents, and the first signs may include change in body odor, breast development, or pubic hair growth. This is then followed by menarche approximately 2 years later. Vaginal bleeding in pre-pubertal female individuals is rare. The aim of this study was to investigate causes of pre-pubertal bleeding in a group of patients.

Design, Setting, Method, and Main Outcome Measures

Seventeen patients who presented with pre-pubertal recurrent vaginal bleeding with no other signs of precocious puberty were investigated, to determine the cause of this symptom.

Results

The mean age for the onset of vaginal bleeding was 7.4 years, ranging from 4 to 9.67 years. Gonadotrophin-releasing hormone (GnRH) stimulation tests showed a pre-pubertal response in all cases. Pelvic ultrasound scans showed a pre-pubertal uterus in all patients. Two patients were found to have foreign bodies identified during a genital examination under anesthetic, and in both cases removal of the foreign bodies terminated the vaginal bleeding.

Conclusion

In conclusion, recurrent vaginal bleeding was not associated with GnRH response, raised estradiol levels, or abnormal pelvic ultrasound findings. In cases of recurrent vaginal bleeding with normal hormonal investigations in pre-pubertal girls, it is recommended that a genital examination under anesthetic be undertaken to rule out undiagnosed causes of the presenting symptom.

中文翻译：

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青春期前女性的阴道出血。

研究目标

青春期是青少年的正常过程，最初的体征可能包括体味改变，乳房发育或阴毛生长。然后大约2年后进行初潮。青春期前女性的阴道出血很少。这项研究的目的是调查一组患者青春期前出血的原因。

设计，设置，方法和主要成果指标

调查了十七名出现青春期前复发性阴道出血且无其他性早熟迹象的患者，以确定该症状的原因。

结果

阴道出血发作的平均年龄为7.4岁，范围为4至9.67岁。促性腺激素释放激素（GnRH）刺激试验显示在所有情况下青春期前都有反应。盆腔超声检查显示所有患者均处于青春期前子宫。在麻醉下的生殖器检查中发现两名患者发现异物，并且在两种情况下，异物的清除均终止了阴道出血。

结论

总之，阴道再次出血与GnRH反应，雌二醇水平升高或盆腔超声检查结果异常无关。如果青春期前女孩阴道分泌物复发且阴道激素检查正常，建议在麻醉下进行生殖器检查，以排除出现症状的未确诊原因。