Anek Aribarg, Vorapong Phupong 
Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand 

Abstract 
The leech is an important cause of vaginal bleeding among rural Thai children. This problem has neither been reported in Europe nor the United States. We describe 10 children aged between 5-10 years seen during a period of six years with a history of leech entering their vagina. There was variable severity of bleeding; three cases were mild and ceased spontaneously, six cases were severe and needed medical intervention, and one case was very severe and required blood transfusion. We propose a protocol for management of this problem which has resulted in a satisfactory outcome in all cases. If the bleeding ceases after a short period of observation, no further treatment is required. If the bleeding persists, the vagina should be examined and irrigated with physiological saline solution, to clean the bleeding point thoroughly and to ensure that the leech saliva is completely removed. Then, the vagina should be firmly packed with gauze, which is removed after 24 hours. Keywords: vaginal bleeding, children, leech