Women with abnormal bleeding noted in the genital area often present with a complaint of vaginal bleeding. Clinicians often attribute the bleeding to a uterine source, but it may arise from disease at any anatomic site in the lower genital tract (vulva, vagina, cervix) or upper genital tract (uterine corpus, fallopian tubes, ovaries). The source of bleeding may also be a nongynecologic site, such as the urethra, bladder, or anus or other bowel site. The differential diagnosis of genital tract bleeding is listed in the table (table 1). The differential diagnosis of genital tract bleeding varies by age group (table 2).
An overview of the differential diagnosis of genital tract bleeding in women will be reviewed here. The evaluation of women with abnormal uterine bleeding (AUB) is discussed separately. (See "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women" and "Overview of the etiology and evaluation of vaginal bleeding in pregnant women" and "Postmenopausal uterine bleeding".)
Bleeding from the ovary rarely presents as vaginal bleeding. Ovarian bleeding is most likely to be found intraperitoneally. Infrequently, bleeding from an ovarian mass, trauma, or infection may pass through the fallopian tube and continue to the lower genital tract.
Ovarian cancer — Vaginal bleeding is an uncommon presentation of ovarian cancer [1,2]. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis", section on 'Other symptoms'.)
FALLOPIAN TUBAL BLEEDING
Similar to bleeding from the ovary, blood from the fallopian tube may rarely pass through the uterus and present as vaginal bleeding. However, this is unusual and most fallopian tube bleeding is found intraperitoneally. Etiologies of fallopian tubal bleeding include tubal pregnancy, neoplastic disease, trauma, and infection.