I promised a hard scenario, consider it delivered.

[jjesusfreak01]

I was leaning toward miscarriage, or some form of obstetrical emergency, however, I'm not sure I would ever get all that information in an exam since we were told repeatedly that unless there is a serious reason to examine the genitalia we are to leave that up to the hospital to examine. I would not have known if she was bleeding vaginally unless it was to an extent that it was obvious enough to observe. Sort of makes me question our training. And yet, I'm not so comfortable looking at an elderly patient and saying "excuse me mamm but can I look at your vajayjay?"

Ask the patient, "are you bleeding anywhere you know?". If they say "yes, my vajayjay", then get them a 5x9 or a trauma dressing to soak up the blood. If they don't know where it's coming from (which I understand in 99% of cases would end up being the vagina, because where else are you going to be bleeding from and not know it) then you have yourself a trauma and you need to see it yourself. Also, elderly patients very likely don't care what you see on their body. Of course you ask first, but those parts stopped being "sexually oriented" a long time ago for them.