Red flags The following findings are of particular concern: Excessive bleeding Hemodynamic instability (tachycardia, hypotension) Premenarchal or postmenopausal vaginal bleeding Vaginal bleeding in pregnant patients In children, difficulty walking or sitting; bruises or tears around the genitals, anus, or mouth; and / or vaginal discharge or pruritus suggestive of sexual abuse. Interpretation of findings Significant hypovolemia or hemorrhagic shock is unlikely except with ruptured ectopic pregnancy or, rarely, a ruptured ovarian cyst.