vaginal bleeding is usually considered to be a foreign body inserted into the vaginal canal, which is frequently associated with pelvic pain, foul discharge, or recurrent genitourinary infections. this event can be due to normal self-exploration or can be indicative of sexual abuse. genitourinary injury is also a common cause, and is often the most common cause of hospitalization or emergency department visits for prepubertal vaginal bleeding, comprising up to 45% of such cases. the most common genitourinary injury is the straddle injury, which often occurs during a fall, often on a sharp edge, and can cause lacerations between the labial folds. treatment while many forms of vaginal bleeding are normal and do not require treatment, other forms will require medical attention. hormonal management is usually the first option used to treat acute abnormal uterine bleeding. these hormonal medications include birth control pills, medroxyprogesterone acetate (brand name depo-provera), and conjugated equine estrogen. long-term treatments include hormonal iud insertion, birth control pills, progestin pills or progestin shots (depo-provera), and nsaids such as ibuprofen certain medications may not be safe for certain women. women with blood clotting disorders may also need to see a hematologist. surgical treatments may also be considered if the bleeding is severe or if there are reasons patients cannot take the hormonal medications listed above. these options include dilation & curettage, endometrial ablation, and hysterectomy (removal of the uterus). hysterectomy will result in infertility, so surgical decisions will include women's preferences regarding future fertility when possible.