Genital bleeding in prepubertal girls: a systematic review

Area of Science:

• Pediatrics
• Gynecology
• Forensic Medicine

Background:

• Genital bleeding in prepubertal girls can be misattributed to abuse.
• Existing literature, including the 2015 Purple Book, requires updating.
• Distinguishing medical causes from abuse is critical for accurate diagnosis and care.

Purpose of the Study:

• To systematically review evidence on the causes of genital bleeding in prepubertal girls.
• To identify medical conditions presenting with genital bleeding, excluding child sexual abuse and accidental injuries.
• To provide an updated evidence base for clinicians.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, and Scopus databases.
• Inclusion of primary studies reporting genital bleeding in prepubertal girls (March 2014 - June 2023).
• Data extraction focused on medical conditions causing genital bleeding.

Main Results:

• 99 studies involving 672 girls met the criteria.
• Common causes included lichen sclerosus, infections, infestations, hormonal issues, urethral prolapse, foreign bodies, and tumors.
• Significant heterogeneity precluded meta-analysis.

Conclusions:

• Multiple medical conditions can cause genital bleeding in prepubertal girls.
• These conditions can mimic or co-occur with child sexual abuse.
• Findings support and update the diagnostic guidance for clinicians.