Genital bleeding in prepubertal girls: a systematic review

Abstract

Introduction: This systematic review aims to collate evidence of the causes of genital bleeding, other than child sexual abuse and accidental injuries, presenting in prepubertal girls. It provides an update to the 2015 Royal College of Paediatrics and Child Health publication 'The Physical Signs of Child Sexual Abuse', an evidence-based review also known as the Purple Book.

Methods: MEDLINE, EMBASE and Scopus databases were searched for studies published between March 2014 and June 2023. Eligible studies were primary studies reporting on genital bleeding with extractable data for prepubertal girls.

Results: 99 studies, describing a total of 672 prepubertal girls, met the inclusion criteria. The most common medical conditions with genital bleeding as a presenting feature were lichen sclerosus, infections and infestations, hormonal causes, urethral prolapse, vaginal foreign bodies and tumours. Meta-analysis was not possible due to the large heterogeneity of the studies.

Conclusion: This review added further evidence to the 2015 edition of the Purple Book, describing the multiple medical conditions that may present with genital bleeding. Several of these conditions can mimic the presentation of child sexual abuse or may coexist with child sexual abuse.

Keywords: Child Abuse; Child Protective Services; Paediatric Emergency Medicine; Paediatrics.