Genital trauma and vaginal bleeding: is it a lapse of time issue? A case report of a prepubertal girl and review of the literature

Abstract

Child victims of sexual abuse may present with physical findings whose interpretation requires the most exhaustive evaluation and an accurate collection of a detailed history. Genital bleeding is usually considered as an acute sign, related to a trauma that occurred shortly before its appearance. We report a case of a 34-month-old child who was referred to the emergency room with a significant vaginal hemorrhage, originating from a wide laceration of the posterior fourchette, and a negative history for accidental trauma. The characteristics of the lesion, compared to the temporal evolution of the healing process, and the witnesses' depositions led us to assume that the time elapsed between the abusive event and the physical examination was longer in respect to what had appeared at the first sight. The judicial reconstruction of the events confirmed our assumption, allowing the charge of the right abuse perpetrator. As the literature regarding this eventuality is very poor, we report this case to stress the importance for physicians to consider that an active bleeding may be the manifestation of a trauma that occurred very long before.

Rare (uro-)genital pathologies in young girls mimicking sexual abuse

“…In contrast to the “myth” that (vaginal) penetration is one of the main reasons for vaginal bleeding in children, Zhang et al [ 11 ] showed that predominant causes for vaginal bleeding in girls aged from 10 month to 10 years are foreign bodies, followed by vulvovaginitis and accidental vulvar trauma. Kelly et al [ 12 ] report that physical symptoms such as vaginal bleeding were of no value in discriminating sexually abused children from those who had not been abused; and Russo et al [ 13 ] pointed out that even bleeding from injuries after sexual violence could be delayed by several hours.…”

“…Another particularity of the malformation is the absence of visible wound healing. Injuries heal rapidly, often ad integrum, within days to weeks, whereas the spontaneous epithelialization of a perineal groove usually takes at least several months, in some cases even years [ 6 , 9 , 13 ]. An incomplete—anterior (15.3% of the cases) or posterior (30.7%) [ 6 ]—perineal groove may be even more difficult to recognize.…”

A case report and literature review of vaginal bleeding in prepubertal girl

“…Trauma, however, usually results in different degrees of damage to the vulva, hymen and vagina in addition to bleeding. These aetiologies can usually be readily detected on genital examination 7,8 . As our patient visited the outpatient department for intermittent bleeding and lacked a history of trauma as well as signs of external genital injury, traumatic aetiologies were effectively ruled out.…”

“…These aetiologies can usually be readily detected on genital examination. 7,8 As our patient visited the outpatient department for intermittent bleeding and lacked a history of trauma…”

Prepubertal Vaginal Bleeding: An Inpatient Series from a Single Center in Fujian China

“…One case of omentum majus prolapse due to vagina injury by pulley puncture has been reported. 16 Sexual abuse accounts for up to 11% of cases of vaginal trauma with bleeding in girls 17 ; thus, a detailed medical history and careful physical examination are required. Through the above methods, we did not find vaginal bleeding caused by sexual abuse in this study.…”