In newborn females, the placental transfer of estradiol and gonadotropin is responsible for a mucoid or blood-tinged vaginal discharge, minor breast development, and vaginal flora similar to that in adult women. Uterine bleeding secondary to estrogen withdrawal may occur in the first 6 weeks of life in normal neonates. Bleeding after this time is always abnormal and requires investigation.
By definition, prepubertal children lack secondary sex characteristics. The labia and mons have less fatty tissue than in adults and lack protective hair. The labia minora are thin, and there is less distance between the anus and the vaginal introitus. The thin vaginal epithelium of prepubertal girls is similar to that of postmenopausal women.
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