Abnormal Vaginal Bleeding in Premenarchal Girls

Question 1

Definition of precocious puberty

Answer 1

• appearance of secondary sexual characteristics before 8 yrs or
• onset of menarche before 9 yrs

Question 2

Local causes of vaginal bleeding

Answer 2

• vulvovaginitis/ infection
• foreign body
• trauma
• urethral prolapse
• hymenal tags
• vulval skin disorders (lichen sclerosis, warts, haemangioma)
• sarcoma botryoides
• other rare malignancies

Question 3

Causes for endometrial shedding

Answer 3

• physiological (neonatal)
• premature menarche
• exogenous oestrogens (pills, food)
• endogenous oestrogen (functional cyst, oestrogen-producing factors)
• precocious puberty (idiopathic/ CNS lesion)

Question 4

Treatment of idiopathic precocious puberty

Answer 4

• suppress the GnRH (otherwise the long bones will close prematurely)

Question 5

Treatment of lichen sclerosis

Answer 5

• potent steroid cream

Question 6

Treatment of urethral prolapse

Answer 6

• oestrogen cream (Premarin)

- excision

Question 7

Treatment of vulvovaginitis

Answer 7

• pus swab
• use Premarin cream (to change pH) for 2 weeks
• treat according to M+S