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Purpose of Review: Indications for vaginoplasty include congenital conditions such as adrenal hyperplasia, cloacal malformations, and Müllerian agenesis, acquired conditions including stenosis from radiation or surgical resection for malignancy, and gender affirmation. All vaginoplasty techniques carry significant risk of both immediate and long-term complications., Recent Findings: The purpose of this study is to provide a review of the evaluation and management of the neovagina, addressing management of human papilloma virus infections and complications including stenosis, fistula, prolapse, and neovaginal colitis., Summary: Gynecologists who care for patients who have had a vaginoplasty need to understand the importance of long-term follow up and care, including evaluation and management of complications.

Objective: To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress., Design: Longitudinal survey., Setting: Two hospital-based colposcopy clinics., Population: Women with abnormal cytology who underwent colposcopy (±related procedures)., Methods: Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables., Main Outcome Measures: Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress., Results: Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up., Conclusions: The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress., Tweetable Abstract: Experiencing multiple physical after-effects of colposcopy is associated with psychological distress., (© 2017 Royal College of Obstetricians and Gynaecologists.)

Background: Vaginal bleeding is a rare occurrence in infancy and childhood. It is usually due to trauma, child abuse, foreign bodies, and rarely, a friable botryoid tumor., Case Summary: We discuss a case of a vaginal müllerian duct papilloma in a 2 year old infant that presented with vaginal bleeding., Discussion: To our knowledge, this is the second case reported in the literature of a vaginal müllerian duct papilloma presenting in a toddler. This rare type of tumor has an excellent prognosis when completely excised., Summary: A 2-year-old female that presented with bloody spotting in the diaper was found to have a vaginal.

Background: Early diagnosis of sexually transmitted infections (STI) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) is crucial in reducing complications. Vaginal bleeding (VB) has been suggested as a possible presentation of STI., Objective: To identify the rate of STI in sexually active women presenting to the emergency department (ED) with VB., Methods: Prospective observational study of females 18-55 years-old presenting to two affiliated urban EDs with VB (convenience sample). Patients with recent STI or antibiotic use (< 3 months) were excluded. To estimate the background rate of STI, we enrolled women with no genitourinary complaints as controls. Specimens for CT and NG were obtained during speculum exam from cases and by self administered vaginal swab in controls. All specimens were analyzed by polymerase chain reaction. Continuous data was presented as mean +/- standard deviation and categorical data as percentages with 95% confidence intervals CI). Fisher's exact test was used to compare the rate of STI between the groups., Results: From 09.06 to 08.07 a total 273 subjects were enrolled (174 VB and 99 controls, mean age: 33 +/- 10). Groups were similar with regards to baseline characteristics. The majority of STI cases were due to CT: 5.8% in VB group (95% CI, 3.2%-10.4%) vs. 7.1% in controls (95% CI, 3.5%-14.0%). The STI rate was 6.3% (95% CI, 3.5%-11.1%) in VB patients and 8% (95% CI, 3.9%-15.3%) in controls., Conclusions: Our ED patients with and without vaginal bleeding had comparable rate of STI.

Coital injury causing severe vaginal laceration is not uncommon during first coitus. However, hemorrhagic shock during consensual sexual intercourse is quite rare. In this report, there was one 30-year-old, 20-year-old one, and one 24 year-old women who suffered severe vaginal laceration and bleeding during the process of consensual coitarche. All subjects were transferred to the hospital in the condition of impending shock. We found that the lacerated sites were located at right posterior fornices in all cases. We postulate that these vulnerable sites of vaginal laceration may be due to the dextro-rotation characteristics of the uterus and the distensibility of the vagina in this area. The vaginal fornix can be extremely distended during sexual intercourse, making it vulnerable to laceration in this area. Besides, there was a disproportionate genital size in all three cases which may be a cause of vaginal laceration. It is critical that such patients receive a prompt diagnosis to provide efficient management. It needs only simple surgical skills to cure the injury if the vital signs are stable. However, those survivors may need further psychological consultation to prevent negative impact on their future sexual functioning.

Background: Arteriovenous malformations are composed of large, tortuous arteries and misshapen, veinlike structures. They are extremely uncommon in the genital tract., Case: An arteriovenous malformation in a Bartholin gland presented as intermittent vaginal bleeding in a 43-year-old woman., Conclusion: Persistent unexplained bleeding from Bartholin's gland requires surgical excision.

Abnormal vaginal bleeding is common in young women and there are many possible causes. The most serious cause is cancer of the cervix which is curable in its early stages and this diagnosis should not be missed.

Profuse bleeding after voluntary sexual intercourse is an uncommon reason for admission to the gynaecological wards. Out of 12 such patients admitted to the Ipoh Hospital over a three-year period, one patient had life-threatening upper vaginal injury after coitus. Blood replacement and conventional suturing failed to arrest the bleeding. Bilateral internal iliac artery ligation promptly arrested further haemorrhage. Vigorous intercourse increases intra-abdominal pressure in women causing tensing of the cul-de-sac, decreasing the elasticity of the posterior fornix, resulting in vaginal laceration. Bilateral internal iliac artery ligation produces a 'pelvic compartment hypotension' converting a high arterial flow system to that of a low one resembling venous flow. The useful role of this procedure to contain pelvic haemorrhage is discussed.

This 13-year-old girl presented with a four-day history of increasing lower abdominal pain associated with heavy vaginal bleeding which was now resolving. Her last normal menstrual period was 19 days before this incident, with a history of regular periods. Repeated questioning revealed a history of the patient engaging, for the first time, in consensual sexual intercourse one day prior to the onset of complaints. The abdominal examination revealed mild lower abdominal tenderness without rigidity or guarding. The pelvic examination failed to reveal any active bleeding, laceration, or findings suggestive of pelvic inflammatory disease. Routine laboratory studies revealed an elevated white cell count. As the patient's pain worsened over the next two to three hours, surgical and obstetric-gynecologic consultations were made, and both services advised overnight observation. Over the next 12 hours her abdominal examination revealed increased rigidity, and the patient was taken to the operating room with the a preoperative diagnosis of ruptured appendix. On exploratory laparotomy a hemoperitoneum was found, and approximately 600 ml of blood were suctioned from the peritoneal cavity. A 2-cm posterior vaginal wall laceration was subsequently repaired and a normal appendix removed.

Urethral prolapse is an uncommon disorder in girls, usually presenting as "vaginal" bleeding. This retrospective chart review focuses on the high rate of misdiagnosis of urethral prolapse and describes treatment modalities based on 24 patients seen at a major children's hospital during an 11-year span. Their mean age was 4.9 years. The initial diagnosis, made by the referring pediatrician or emergency physician, was correct in only five girls (21%). Twenty children presented with urogenital bleeding. Operative correction was employed as initial treatment in 16 girls, with one recurrence. The remaining eight children were treated nonoperatively. Of these, five showed no improvement and underwent surgical repair. Although most children eventually require resection of the prolapsed urethral mucosa, nonoperative treatment is appropriate for asymptomatic girls with a mild degree of urethral prolapse. Increased physician awareness of urethral prolapse is desirable to enhance early recognition and to avoid unnecessary examinations and parental concern.

We report on two cases of vaginal bleeding after hysterectomy. These patients suffered from cyclical therapy resistant vaginal bleeding and complaint in the lower abdomen. The final diagnosis and therapy of a vaginal cuff endometriosis made it possible to eliminate the persistent clinical symptoms. These cases show the need for a discussion on the necessity of a special operative procedure in case of endometriosis genitalis interna and externa.

In a six-year-old child presenting with vaginal bleeding, considered to be the consequence of sexual abuse by a stepfather, a colposcopically identified vaginal lesion was biopsied. This showed a chronic inflammatory lesion which could have been the consequence of recurrent, self-inflicted, masturbatory injury. Various controversial aspects of this case are discussed.

Endodermal sinus tumor (EST) of the vagina is extremely rare and primarily affects infants. We report on a six-month-old female infant with EST of the vagina who presented with vaginal spotting of one month's duration. Pelvic ultrasound and computerized tomography showed a 3.8 x 3.5 cm heterogeneous mass between the bladder and the rectum. The serum alpha-fetoprotein (AFP) level was high (1270 ng/mL) and the beta-human chorionic gonadotropin was undetectable. She received surgical intervention followed by chemotherapy. The patient was disease-free and serum AFP remained undetectable during the eight-month follow-up period.

Congenital arteriovenous malformation (AVM) of the female pelvis is a rare but potentially life-threatening condition. An unusual presentation of AVM involving the vagina, abdominal wall, spleen and thigh, with profuse hemorrhage from a vaginal ulcer is described. Doppler, real time ultrasound and computerized tomography were useful in confirmation and delineation of the extensive AVM in this case. Angiography and embolization were thought risky and possibly unnecessary. Bleeding stopped with bed rest and vaginal packing with gauze soaked in 3% hypertonic saline. The ulcer healed after 3 months with conservative management. The risk of future problems was explained to the patient and follow-up was advised. Undertreatment of AVM may be preferable to overtreatment, and the aim should be 'control' rather than 'cure'.

Vaginal bleeding in early childhood, regardless of its duration and quantity, is always of clinical importance. This article discusses the examination of the child and adolescent and reviews the various causes of vaginal bleeding in these patient groups.

Persistent bleeding from the vulva was the only presenting clinical sign in five non-pregnant pluriparous mares varying in age from eight to 20 years. These were two hunter types, one shire, one thoroughbred and one Arab pony. The haemorrhage originated from ulcerated varicose veins present on the dorsal wall of the vagina adjacent to the vestibulovaginal junction. All five mares were successfully treated, by submucosal resection (two), ligation of vessels (two) or diathermy (one). In four mares there was evidence of vulval incompetence caused by depression of the perineum. The importance of this and the role of impaired venous return during and after pregnancy are discussed.

A case is reported of a woman who presented with bleeding from a vaginal extension of a synovial sarcoma. The patient was unaware of the primary tumor in the left thigh and histologically, the tumor resembled a carcinosarcoma. Awareness of the physical and radiologic findings allowed the correct pathologic diagnosis to be made. The manner of presentation of the tumor is believed to be unique.

In a neonatal postmortem histological study of scalp stabs made with a fetal blood sampling blade the aponeurosis was punctured in up to 38% of cases even when it was more than 2 mm deep. This and other indirect and direct evidence discussed suggest that five of the seven reported cases of major bleeding after fetal blood sampling in labour were due to blood clotting defects and that these should be considered urgently in the management of future cases.