- comprehensive history and thorough external genital exam (often without direct visualization of the cervix) will lead to appropriate diagnosis
- estrogen withdrawal following birth or ingestion of oral contraceptives
- vaginal foreign bodies (such as toilet paper, small toys)
- bacterial infections (strep and shigella)
- trauma from sexual abuse or straddle injuries
- vascular lesions such as hemangiomas
- be careful to differentiate urethral bleeding from vaginal bleeding
References
Emans SJ, Laufer MR, Goldstein DP. Vulvovaginal problems in teh prepubertal child. In: Pediatric and Adolescent Gynecology. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1998:75-107