Hello, Thanks for sharing your health concern with us. I have gone through your query and would like to offer my opinion. Going by her age, your daughter is likely to have entered the perimenopause. She needs a proper clinical examination, a pap smear, a sonogram of the pelvis preferably in the trans-vaginal route, exclusion of polyps of the cervix and the endometrium as the cause of the spotting and urinalysis. A hormone assay is also needed. Infections have to be treated and so are polyps, if any. Perineal pressure can also be due to weakened perineal floor and can be dealt with Kegel s exercises to strengthen the perineal floor muscles. Hope this helps.