Approach To Abnormal Vaginal Bleeding

Question 1

Define precocious puberty

Answer 1

Presence of secondary sex characteristics before 8 or onset of menarche before 9

Question 2

List some of the local causes of vaginal bleeding in premenarchal girls

Answer 2

Vulvovaginitis
Foreign body
Trauma
Urethral prolapse
Hymenal tags
Vulval skin disorders (lichen sclerosis, warts, haemangioma)
Sarcoma batryoides
Other rare malignancies of the genital tract

Question 3

List some of the causes of endometrial shedding in premenarchal girls

Answer 3

Physiological (neonatal withdrawal bleeding due to the circulating oestrogen left from mother circulation)
Premature menarche
Exogenous oestrogen (pills, food)
Endogenous oestrogen (functional cyst, oestrogen producing tumour)
Precocious puberty a) idiopathic b) CNS

Question 4

Discuss management for idiopathic precocious puberty in young girls

Answer 4

Suppress GNRH, otherwise the long bones will close prematurely and the girl will stop growing

Question 5

Discuss management of valvular lesions in young girls

a) lichen sclerosis
b) warts
c) urethral prolapse
d) vulvulovaginitis

Answer 5

a) lichen sclerosis - Potent steroid cream
b) warts - Excision or laser
c) urethral prolapse- Oestrogen cream or excision
d) Vulvovaginitis- take pus swab (for mc&s). Premarin cream for 2 weeks. Treat according to m&s