Uterine Fibroids: These are common in women of reproductive age and can cause both hematuria (if the fibroid is located near the bladder or ureters) and per vaginal bleeding due to their potential to distort the uterine cavity or affect the endometrium.

Endometrial Cancer: This can cause irregular vaginal bleeding and, less commonly, hematuria if the cancer has spread to involve the urinary system.
Cervical Cancer: Similar to endometrial cancer, cervical cancer can cause abnormal vaginal bleeding and, in advanced stages, might lead to hematuria if there's local spread to the urinary tract.
Urinary Tract Infections (UTIs): While more commonly associated with dysuria and frequency, severe UTIs, especially those involving the upper urinary tract (pyelonephritis), can cause hematuria. Per vaginal bleeding might not be directly related but could be coincidental or due to a separate gynecological issue.
Kidney Stones: These can cause severe pain and hematuria. While they don't directly cause per vaginal bleeding, the pain and discomfort might lead to straining during urination, potentially exacerbating any existing gynecological condition that causes bleeding.

Ovarian Torsion: Although it primarily presents with acute abdominal pain, ovarian torsion can lead to hematuria if the twisted ovary compresses or involves the urinary tract. Per vaginal bleeding might occur due to the ovarian cyst rupture or necrosis.
Ectopic Pregnancy: This is a life-threatening condition that can cause abdominal pain, per vaginal bleeding, and potentially hematuria if there's significant internal bleeding affecting the urinary system.
Ruptured Ureteral or Renal Vascular Malformation: These rare conditions can cause sudden onset of hematuria and, depending on the location and severity, might also lead to per vaginal bleeding due to the proximity of the vascular malformation to the reproductive organs.

Genitourinary Fistula: An abnormal connection between the urinary tract and the reproductive system can cause continuous per vaginal bleeding and potentially hematuria, depending on the location and size of the fistula.
Schistosomiasis (Bilharzia): In endemic areas, this parasitic infection can cause chronic hematuria and, in females, might lead to per vaginal bleeding due to the involvement of the lower genital tract.
Metastatic Disease: Advanced cancer from other primary sites can metastasize to both the urinary and reproductive systems, potentially causing both hematuria and per vaginal bleeding.