Number one, if she s a very good patient, you ll have the mother lie down on the examining table and have the child lay on the mother s abdomen with her knees up under her, sort of in a knee-chest position, you can sometimes spread the labia and with a light just look up the vagina to see if there s anything up there. If I can t get an exam done and the child is actually having bleeding and so forth, then my choice is to take them to the operating room, put them to sleep. You can do a good visual inspection and you can do a vaginoscopy with a cystoscope. It s very simple, very easy. Sexual abuse is another thing that we think of and we look for signs of.
Exogenous estrogen can be a problem.
She may be picking up her mother s birth control pills and having withdrawal menses because she takes a pill and after awhile, after a few pills that her mother didn t happen to notice were gone, she stopped taking them and has some bleeding. Pregnancy and its complications is a frequent cause. Anovulatory problems are the ones we deal with the majority of times. The patient is having either irregular anovulation or irregular ovulation, or is totally anovulatory. And then anatomical problems in the reproductive years are usually fairly few and far between, although we do see a fair number of patients that The reasons many patients have the anovulatory type of bleeding, the endocrine problems we see with thyroid, pituitary.