The below are example red flags for genitourinary symptoms. Other red flags can exist, and clinical acumen is required. If red flags are present, consider urgent referral or admission.
For more information on genitourinary symptoms and red flags, see NICE CKS guidance.
Endometrial cancer
Postmenopausal bleeding (vaginal bleeding >12 months since last period)
Bleeding after a spell of amenorrhoea on HRT
Bleeding that does not settle after using continuous combined HRT for 6 months
Persistent intermenstrual bleeding
Abnormal endometrial thickness or appearance on ultrasound scan
Cervical cancer
Post coital bleeding with no obvious cause such as infection
Persistent intermenstrual bleeding
Abnormal appearance of cervix
Ovarian cancer
Appetite loss, early satiety, abdominal distension
Persistent urinary urgency or frequency in women >50 years
New IBS symptoms in women >50 years or unexplained change in bowel habit
Fatigue and weight loss
Ascites or pelvic mass that is not obviously fibroids
Elevated CA125 or abnormal appearance of ovary on scan
Vaginal cancer
Unexplained palpable mass at entrance to vagina
Vulval cancer
Unexplained vulval lump, ulceration or bleeding
Bladder cancer
Age >45 years and unexplained visible haematuria without UTI
Age >45 years and visible haematuria that persists or recurs after treatment of UTI
Age >60 years and unexplained non-visible haematuria and either dysuria or a raised WCC
