Prepubertal vaginal bleeding caused by a vaginal foreign body: Diagnostic challenges and forensic implications

Vaginal bleeding in prepubertal girls merits thorough investigation, as it is always pathological and its etiology is broad and includes inflammatory conditions, endocrine disorders, local irritation from a foreign body, neoplasms, injuries, and sexual abuse. The diagnostic approach used should be immediate, systematic, and multidisciplinary.

We present the case of a 7-year-old girl who was admitted to a tertiary pediatric hospital with a history of prolonged vaginal bleeding. During the clinical, pediatric, and forensic investigation, the presence of a foreign body within the vagina was revealed, which consisted of a single hair with presumptively blood-positive material. No findings of recent or past injury to the genitals or anus were found, while the hymen was intact. Autosomal Short Tandem Repeat (STR) analysis of the hair did not yield an interpretable genetic profile; therefore, no inference could be made regarding the presence or absence of DNA from the child or any third party.

The case highlights that the presence of a foreign body, even a rare form such as a single hair, must be considered in the differential diagnosis of prepubertal vaginal bleeding. The combined pediatric, gynecological, and forensic approach facilitated a comprehensive evaluation of the case. The available findings were not supportive of a sexual abuse etiology; however, the absence of supportive findings should not be interpreted as definitive exclusion of sexual abuse.