Howell Jennifer O, Flowers Deborah
Assistant Professor, Division of Women's Primary Health, Department of Obstetrics and Gynecology, and Medical Evaluator, Beacon Child and Family Program, Department of Pediatrics, University of North Carolina.
Program Coordinator/Nurse Consultant, NC Child Medical Evaluation Program, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
Obstet Gynecol Surv. 2016 Apr;71(4):231-42. doi: 10.1097/OGX.0000000000000290.
Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to parents. A variety of practitioners, including obstetrician-gynecologists and pediatricians, may be asked to see patients with this presenting complaint, yet many do not receive adequate training in pediatric gynecology.
Review of the published literature in PubMed, focusing on the last 20 years, regarding the incidence, etiologies, diagnosis, and management strategies for the common causes of prepubertal vaginal bleeding.
Careful history taking and pediatric-specific gynecological examination skills, including awareness of normal anatomy across the age spectrum and the ability to identify an estrogenized hymen, are keys to the appropriate assessment of this clinical problem.
Prepubertal vaginal bleeding has many causes and requires a thorough targeted history and pediatric genitourinary examination, requiring knowledge of the variants of normal pediatric genitourinary anatomy. Most causes can be easily treated and are less likely to be due to sexual abuse or malignancy.
新生儿期以外的青春期前阴道出血总是异常的，这会让家长非常担忧。包括妇产科医生和儿科医生在内的各类从业者可能会被要求诊治有此主诉的患者，但许多人并未接受过足够的小儿妇科培训。
回顾PubMed上发表的文献，重点关注过去20年中有关青春期前阴道出血常见病因的发病率、病因、诊断和管理策略。
仔细的病史采集和针对儿科的妇科检查技能，包括了解各年龄段的正常解剖结构以及识别雌激素化处女膜的能力，是对这一临床问题进行恰当评估的关键。
青春期前阴道出血有多种原因，需要全面且有针对性的病史询问和儿科泌尿生殖系统检查，这需要了解小儿泌尿生殖系统正常解剖结构的变异情况。大多数病因易于治疗，不太可能是性虐待或恶性肿瘤所致。
