Emergency evaluation and management of vaginal bleeding in the nonpregnant patient

Evaluation of the nonpregnant patient presenting to the emergency department with vaginal bleeding requires the emergency physician to be aware of the potential for a variety of underlying causes. Patients with vaginal bleeding may have non-life-threatening problems such as fibroids, endometriosis, or treatable sexually transmitted diseases such as gonorrhea and chlamydial infection. However, care must be taken to differentiate these from more serious causes of pelvic pain and bleeding such as ectopic pregnancy, hemorrhagic cyst, ovarian torsion, and rare complications from fibroids such as intraperitoneal hemorrhage. Abnormal bleeding unrelated to structural problems could have an anovulatory or ovulatory cause.