Vaginal Leech Infestation: a Rare Cause of Prepubertal Vaginal Bleeding and Anemia

Abnormal vaginal bleeding under the age of 10 is rare among girls. In such cases, local lesions, trauma, intra–vaginal foreign body, malignant genital tumors, and precocious puberty should be taken into account. Leech infestation is one of the rare causes of severe prepubertal vaginal bleeding. One case of prepubertal vaginal bleeding due to leech infestation is presented here. An eight–year–old girl referred to the emergency department after three days of painless vaginal bleeding. The bleeding was moderate during the first two days and the patient experienced intensified bleeding and large menstrual clots on the third day. The patient had no history of trauma, coagulation disorder, systemic illness, and drug use, but noted the history of swimming in the muddy creek within a few days before referral to the emergency department. After examining the genital system, a black mass with wavelike movements was observed in the lower one-third of the vagina, and a piece of it was slightly out of the hymen. The leech was removed by forceps without damaging hymen. After a short time, the bleeding stopped. On the next visit, the patient had no vaginal bleeding and was discharged without any problem. In cases of prepubertal vaginal bleeding, accurate examination of the genital system and evaluating the history of swimming or bathing in contaminated creeks, springs, qanats and pools are essential.