Case ReportPreschool Girl With Vaginal Bleeding Due to Pinworm Endometritis
Introduction
Genital bleeding in a girl without signs of pubertal development is cause for alarm and poses a diagnostic and prognostic dilemma, given its great etiological diversity including infections, tumors, foreign bodies in the vagina, genital trauma, and also non-gynecological diseases. In addition, because of the low prevalence of this entity, there are limitations for the gynecological examination of prepubertal girls for many doctors, due to a lack of experience and the limited availability of appropriate instruments.
The basic knowledge of all the potential causes is essential in order to carry out an exhaustive evaluation and/or to be able to consult the appropriate specialist if necessary.
Section snippets
Case
An otherwise healthy girl 3 years 4 months of age attended the Emergency Pediatric Unit because of genital bleeding without other associated symptoms. Physical examination showed breasts and pubic hair at a Tanner I stage. Genital inspection revealed female genitalia without signs of estrogenization and no injuries, annular hymen without notches, and multiple blood clots without bad odor, emerging from the vaginal orifice. The perineal and anal regions were unremarkable. A vaginoscopy was
Prepubertal Vaginal Bleeding
The large number of diagnostic possibilities makes it essential to perform a thorough evaluation of the patient. It is also important to have a rational approach to the child, both to first rule out the most frequent causes and to avoid unnecessary invasive procedures.1
The general physical examination must evaluate the clinical impact of bleeding and the pubertal stage, and search for any sign of systemic disease. It is also necessary to rule out extra-gynecological causes such as anal or
Summary and Conclusions
Enterobiasis, given its frequency and the diversity of its manifestations, should be included in the differential diagnosis of gynecological diseases at any age, whether the cardinal symptom is genital itching, vaginal discharge, or abnormal genital bleeding.
As our report shows, pinworms can invade the uterine cavity of girls. Therefore, in prepubertal girls with abnormal genital bleeding, this infection should be included into the differential diagnosis. If pinworm infestation is confirmed (by
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The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.