Epidemiology

ED visits for vaginal bleeding or pelvic pain by women of reproductive-age are common. It is estimated that 5 percent of women aged 30 to 49 years will consult a physician for treatment of menorrhagia.1 An Australian review of Pap smear requests for women aged 20 to 69 documented that 1 in 20 had abnormal bleeding.2 Although this data may not be generalizable to the ED, it does emphasize the point that abnormal vaginal bleeding is common. Population-based data are not available for children and adolescents.

In a cross-sectional survey of reproductive-age women who presented to a primary care setting, 90 percent reported some dysmenorrhea, 38 percent experienced dyspareunia sometimes, and 39 percent reported other types of pelvic pain.3 Overall, pelvic pain is most common in 18- to 30-year-old women. Prevalence does not vary significantly by education, parity, or race.3 Diagnoses made on the basis of history and physical examination may overestimate the prevalence of pathology. In studies of women with pelvic pain who were referred for laparoscopy, 17 percent of adolescents and 16 percent of reproductive-age women had normal findings on examination.45

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