Ovarian cysts are not uncommon in the neonatal period, and small (follicle) cysts are present in approximately 90% of newborn females. These cysts occur in response to maternal estrogens, and in 20–30% of cases, the cyst may be more than 1 cm in diameter. The cysts usually resolve gradually after birth as the gonadotrophin levels reach prepubertal levels by 2–3 years of age. Complex ovarian cysts are identified on ultrasonography (US) by a multi-septate appearance which is most commonly due to bleeding into the cyst or torsion. Other genital conditions include labial adhesions, hymenal abnormalities, vaginal and uterine abnormalities. Vaginal bleeding in the premenstrual female infant is a not uncommon and is distressing for patients and their families.