I really intended to stay out of this one, and it looks like a consensus has already been reached. But after reading all the replies, I think this issue is A. being blown way out of proportion (MATEO !) and B. Being made way too complicated.
Take it from a 20-something year old female, the population I believe that you are most likely to encounter with ob/gyn emergencies and the least likely to be educated about what exactly is going on. Pelvic/vaginal examinations, be they visualization or palpation, should be done a very strictly need-to-know basis. It will not and should not change our treatment, and spare me the 12 lead argument. There is just too much risk in this highly litigious society, especially for male providers, without any real proximate benefit. All we really need to be assessing for down there is excessive bleeding or presentation of a baby's head. If your patient is pregnant, a lot of that modesty is probably out the window anyway and a visual check for crowning is acceptable but should be done discreetly. If there is excessive bleeding you are probably going to see it. And even if you don't, you can ask in a way that even the stupidest chromosomal deficient piece of trailer trash can understand. A simple, how many times in the last 30 minutes have you had to change your pad or tampon question should give you an understanding of what you are dealing with. Some are claiming that we can't take the patient's word for how much they are bleeding and it may not be apparent, (ie we can't treat what we can't see). Well I say that any half-ass decent paramedic should be very closely monitoring any patient with vaginal bleeding, regardless of how much they claim it is or even what they see. Like Spenac said, they could be compensating with normal vitals. We should be prepared to aggressively treat hemorrhagic shock in these patients and checking out their crotch isn't going to be able make us any better prepared to do that than we already should be.