Past medical history reveals a full term child without history of prenatal or postnatal complications. There are no chronic medical illnesses and no recent medications. Immunizations are up to date and there are no allergies. The child was developmentally appropriate for age and the social history was unremarkable. On review of systems, pertinent negatives included no history of chronic constipation, no recent abdominal trauma, no easy bruising or bleeding, and no history of the mother being treated with DES during the pregnancy of this child.
Physical exam reveals a playful and interactive child in no distress.
Vital signs and growth parameters all are within normal limits. Pertinent positives on exam were limited to the genitalurinary system. The child was Tanner SMR Stage 1. The patient had obvious spots of bright red blood in her underwear. There was mild erythema and bruising of the labia majoria.