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eight years old bleeding

hi I have a daughter and she is eight years old. for the past month I see a little blood coming from her vigina. it happens when she goes to the bathroom and has bowel movements. we approached two gynecologist that sent us for hormone checkups and blood test and a viginanal check up. all check ups came back good but the bleeding still appears when she has bowel movement. I would appreciate your opinion.  thank you very much.
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603463 tn?1220630455
If your daughter was my patient, I would wonder about a few things--one is whether there might be a foreign body (such as a bit of toilet tissue) lodged deep in the vagina.  I would irrigate the vagina and look inside with a hysterosope.  I would also do a urine check to make sure it isn't a bladder infection.  I would ask about and check for any other signs of puberty such as breast development and pubic hair--wondering if she is simply developing early and having a menstrual period (blood tests for hormone levels would be useful too).  I must also say that I would test for sexually transmitted infections and I would ask about and check for any signs of that.  (Have to be very thorough).  Finally, and almost I think the most likely thing--I would check her stool for infection/parasites and her little rectum to see if she has any fissures or fistulas (cracks or openings caused by hard bowel movements) because maybe the blood is coming from the bowel instead of the vagina.  Pinworms is another possibility.
I think I have been through a fairly exhaustive list of things that it could be.
I hope that this is of some help to you.  Obviously, if I saw you and her it would help me immensly to narrow down the list.
BUT--if you can find a pediatric or adolescent gynecologist in your area that would be an excellent physician to work with.
I hope she gets better!
Dr B
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