Children with vaginal bleeding that is not associated with normal puberty should have a thorough evaluation by their Pediatrician and/or a Pediatric Gynecologist and perhaps an Endocrinologist if a hormonal cause is suspected.

Abuse should be suspected if there is unexplained trauma and/or bruising associated with the bleeding.

Vulvovaginitis: Young girls sometimes complain of burning or pain when they urinate (dysuria), and although this can sometimes be a sign of a urinary tract infection, it is more commonly caused by irritation of the skin in and around the vaginal area (vulvovaginitis) or at the opening of the urethra (urethritis). This irritation can also cause bleeding, vaginal itching and frequent urination (frequency). Before puberty, the skin around the vaginal area can be very sensitive, and it can easily become red and inflamed when it comes in contact with common irritants, such as soap or shampoo. Bubble baths are also a common irritant that can cause itching in the vaginal area. Another cause of vulvovaginitis is poor toilet hygiene, which is usually secondary to not wiping or wiping incorrectly after urinating.

Pinworms: small (1/4 -1/2 inch long), white worms that look like small pieces of thread that cause itching around the anus (without a rash), especially at night. It can also sometimes cause vaginal itching, which if severe enough, can lead to bleeding.

Foreign body: sometimes a foreign body, such as a piece of toilet paper, can be trapped in the vagina, causing bleeding, discharge, pain or itching.