A six years old girl child presents with spotting, no secondary sexual characteristic present. Cause can be:

Because there is no signs of infection or menarche, foreign body is the best answer. Hemorrhagic disease will not appear as spotting. Causes of vaginal bleeding in children: Foreign body Genital tumors Urethral prolapse Lichen sclerosus Vulvovaginitis Condyloma acuminata Trauma Precocious pubey Exogenous hormone usage Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 14. Pediatric Gynecology. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.