Most cases of genital redness, itching, discharge, bleeding, or pain in prepubertal girls have benign causes and respond to the removal of irritants.However, because a genital complaint such as discharge or bleeding may be caused by trauma to the area or a sexually transmitted infection, assessment of each patient requires the clinician to be sensitive to possible unspoken concerns of parents regarding suspicions of molestation.Understanding the wide variations in the appearance of the hymen and other genital tissues in prepubertal girls is also necessary.In 2013, the American Academy of Pediatrics published an updated clinical report on the subject of suspected child sexual abuse with guidance for the clinician in deciding when a report to protective services is necessary.Genital complaints in prepubertal girls are not rare, and all clinicians who examine children need to be familiar with the conditions that can cause genital redness, itching, discharge, bleeding, and pain.Physicians, nurse practitioners, nurses, and physician assistants who examine children must know the wide variations of normal in the appearance of the genital tissues so as not to unnecessarily raise the suspicion of sexual abuse if the child gives no disclosure.
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