🩸 Vaginal Bleeding · Schwartz Chapter 79

Premenarchal & postmenarchal · trauma · foreign body · urethral prolapse · precocious puberty · dysfunctional uterine bleeding · pregnancy

Age-based approach – distinguish life-threatening causes (ectopic pregnancy, malignancy, severe trauma) from benign (neonatal withdrawal, physiologic leukorrhea, vulvovaginitis).
⚠️ Red flags: profuse bleeding, hemodynamic instability, syncope, abdominal/pelvic mass, suspected sexual abuse, pregnancy in adolescent.

📋 Step 1 — Select patient profile & clinical clues
📌 Differential & next steps
📖 Schwartz Ch 79 (Vaginal Bleeding)

Choose age group (premenarchal vs postmenarchal), associated symptoms, bleeding pattern, trauma, discharge, or pregnancy status → tool suggests most likely etiology (foreign body, urethral prolapse, trauma, DUB, pregnancy complication, malignancy) and provides management recommendations.

✔️ Premenarchal: trauma, foreign body, urethral prolapse, lichen sclerosus, sarcoma botryoides.
✔️ Postmenarchal: pregnancy complication, dysfunctional uterine bleeding, PID, bleeding disorder.
✔️ Always consider sexual abuse in any child with unexplained genital bleeding/injury.
📘 Schwartz management pearls
• Premenarchal exam: gentle labial traction ± vaginoscopy if foreign body suspected.
• Urethral prolapse: topical estrogen + sitz baths. Surgery if necrotic.
• Dysfunctional uterine bleeding: NSAIDs + OCPs if anovulatory; rule out coagulopathy.
• Ectopic pregnancy: quantitative β‑hCG, transvaginal ultrasound, immediate gynecology consult.