Chapter 92 Gynecology Emergencies Every sexually active patient with abnormal vaginal bleeding should be screened for N gonorrhoeae and C trachomatis genital tract infections Cervicitis or pelvic inflammatory disease may also be caused by Mycoplasma genitalium or Ureaplasma urealyticum, though commercial testing for these pathogens is not widely available Bleeding genital warts should not be treated with topical podophyllin because toxic amounts of the resin can be absorbed systemically (see Chapter 92 Gynecology Emergencies ) Referral to a specialist is recommended Trauma The evaluation and management of victims of sexual assault are discussed in detail in Chapter 127 Sexual Assault: Child and Adolescent Hymenal tears produced by coitus rarely require treatment beyond reassurance More significant trauma may occur necessitating a careful physical examination Retained foreign body such as a tampon or condom can cause vaginal bleeding Evaluation via bimanual examination, speculum examination, or ultrasound may be helpful Hematologic Hematologic causes of AUB are relatively rare The most common hematologic cause of excessive menstrual bleeding is thrombocytopenia caused by idiopathic thrombocytopenic purpura, hematologic malignancy, or chemotherapeutic agents Clotting factor disorders produce heavy bleeding much less frequently than does thrombocytopenia, but von Willebrand disease should be considered in the differential diagnosis, especially when heavy bleeding has been present since menarche Treatment Options The treatment for adolescents with AUB depends on the underlying cause and the severity of the bleeding AUB is categorized as mild, moderate, or severe based on the measured hemoglobin level Mild bleeding (hemoglobin >12 mg/dL) can be managed by close monitoring via a menstrual calendar and careful follow-up The treatment goals of more moderate (hemoglobin 10 to 12 mg/dL) or severe (hemoglobin 160 mm Hg or DBP >100 mm Hg) Current and history of certain heart conditions Certain liver diseases Postpartum (