Postcoital bleeding

What is Post-coital Bleeding?

Post-coital bleeding (PCB) is non-menstrual bleeding that occurs immediately after sexual intercourse.

It can be quite alarming and warrants further assessment

It occurs in up to 1 in 12 women and quite often co-exists with heavy periods.

In younger women the likelihood of infection is high and risk of cancer is extremely low.

In the older women approaching the menopause it can occur in the presence of cervical and endometrial cancer.

1 in 220 women with post-coital bleeding are diagnosed with cervical cancer

What are the causes of post-coital bleeding?

In about 50% of women no cause is identified.

Cervicitis-.Cervical Infection caused by Chlamydia, Gonorrhea and trichomonas vaginalis

Vaginitis-This can be due to thrush, bacterial vaginosis and trichomonas infection or due to lack of estrogen after the menopause

Cervical ectropion/ectopy– is a common cause in young women on the combined oral contraceptive pill.

Polyps– skin tag like lesions that can arise on the cervix and the lining of the womb (endometrium)

Cancer- is a less frequent cause and can occur in the vagina, cervix and uterus.

Trauma-Can be a rare cause following sexual intercourse

What investigations do I need?

A vaginal examination is performed to inspect the vaginal wall and cervix.

Pregnancy test

Swabs are obtained to screen for common infections

Cervical smear test, cervical biopsy and or referral for colposcopy

A trans-vaginal ultrasound scan may be indicated

What treatment options are available?

Treatment will depend on the cause.

In about 50% of patients symptoms resolve spontaneously

Infective Cervicitis and Vaginitis are treated with appropriate antibiotics

Cervical ectropion /ectopy-may resolve spontaneously

It can be treated with silver nitrate or thermal cautery and diathermy

Discontinuing the combined oral contraceptive pill may also be helpful

Cervical polypsare removed and sent for laboratory analysis.

Precancerous cervical abnormalities -Require removal of the abnormal cells by loop diathermy

Cervical cancer – Surgery, radiotherapy and or chemotherapy at a cancer centre

Further discussion during the consultation will depend on your individual circumstance.