Vaginoscopy to investigate vaginal bleeding and discharge in prepubertal girls.

Abstract

Study objective: To investigate the aetiology of vaginal bleeding and discharge in prepubescent girls, and the utility of vaginoscopy for making a diagnosis.

Design: Retrospective observational study over 14 years.

Setting: Two major tertiary referral paediatric hospitals in Sydney, Australia.

Participants: All prepubescent girls (n = 104) who presented with vaginal bleeding and/or discharge and subsequently underwent a vaginoscopy. A total of 120 procedures were performed.

Main outcome measures: Surgical findings at vaginoscopy; number needed to investigate (NNI) to establish a diagnosis and to exclude malignancy.

Results: There were 52/120 (43.3%) vaginoscopies which provided a positive diagnosis, including 36/86 (41.8%) performed for bleeding and 16/34 (47.0%) for vaginal discharge. In the vaginal bleeding group, the causes found were a foreign body in 11/86 (12.7%), vulvovaginitis in 6/86 (6.9%), benign Mullerian papilloma in 5/86 (5.8%), trauma in 4/86 (4.6%), and malignant tumours in 2/86 (2.3%). To establish a diagnosis in girls presenting with vaginal bleeding, the NNI was 2.4; to detect a malignancy the NNI was 43.0. In girls presenting with vaginal discharge, vulvovaginitis was noted intraoperatively in 7/34 (20.6%) and a foreign body was found in 7/34 (20.6%). No malignant tumours were identified in the vaginal discharge group. To establish a diagnosis in girls presenting with vaginal discharge, the NNI was 2.1.

Conclusions: Vaginoscopy is an important diagnostic tool in the setting of vaginal bleeding in prepubescent girls, allowing the ability to confirm a diagnosis, and importantly, to exclude malignancy.