Red flags The following findings are of particular concern: Hemodynamic instability (hypotension, tachycardia, or both) Syncope or near syncope Peritoneal signs (rebound, rigidity, guarding) Fever, chills, and purulent vaginal discharge Vaginal bleeding Interpretation of findings Certain findings suggest causes of pelvic pain but are not always diagnostic (see table Some Causes of Pelvic Pain).