Dwiggins Maggie, Gomez-Lobo Veronica
aOSF Saint Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, IllinoisbMedstar Washington Hospital Center, Children's National Medical Center, Washington, District of Columbia, USA.
Curr Opin Obstet Gynecol. 2017 Oct;29(5):322-327. doi: 10.1097/GCO.0000000000000398.
Prepubertal vaginal bleeding raises many concerns and evaluation and diagnosis may prove difficult for many providers. We aim to provide a comprehensive review and recent updates for those practitioners who care for these patients.
Prompt management in the case of prepubertal vaginal bleeding is indicated, especially to rule out malignancy or abuse. If a child is reluctant to undergo examination, or if the extent of injury or source of bleeding cannot be determined, examination under anesthesia and vaginoscopy is recommended. Use of vaginoscopy allows for clear visualization of the vagina and cervix without distorting hymenal anatomy, as well as diagnosis and removal of a foreign body and evaluation of mucosal damage caused. In the case of sexual abuse, providers specifically trained in pediatrics need to be present, and safety of the patient should always be ensured.
Careful history taking and targeted examination may lead to diagnosis in the case of prepubertal vaginal bleeding. However, in more difficult cases, practitioners should not hesitate to examine a patient in the operating room using general anesthesia to elicit the cause. Although sexual abuse and malignancy are always on the differential, most causes of bleeding are benign and easily treated.
青春期前阴道出血引发诸多担忧，许多医疗人员可能会觉得评估和诊断颇具难度。我们旨在为照料这些患者的从业者提供全面的综述及最新进展。
青春期前阴道出血的情况需要及时处理，尤其要排除恶性肿瘤或虐待。如果患儿不愿接受检查，或者无法确定损伤程度或出血来源，建议在麻醉下进行检查及阴道镜检查。使用阴道镜能够清晰观察阴道和宫颈，而不会扭曲处女膜的解剖结构，还能诊断并取出异物，评估所造成的黏膜损伤。在性虐待的情况下，需要有经过儿科专门培训的医疗人员在场，并且始终要确保患者的安全。
对于青春期前阴道出血的情况，仔细询问病史并进行针对性检查可能会得出诊断结果。然而，在更棘手的病例中，从业者应毫不犹豫地在手术室使用全身麻醉对患者进行检查以找出病因。虽然性虐待和恶性肿瘤始终是鉴别诊断的考虑因素，但大多数出血原因是良性的且易于治疗。
