Inappropriate PV Bleeding

Question 1

Cervical ectropion

Answer 1

Post coital bleeding, persistent vaginal discharge
Florid appearance of mucosa surrounding the external os
Secretory glandular mucosa
Can occur due to hormal changes in puberty, pregnancy or contraceptive pill
STI tests req + smear
No issues but symptomatic -> cryotherapy or diathermy

Question 2

Endometrial polyps

Answer 2

Menstrual irregularities
(Dysmenorrhoea / post coital bleeding if protrude through cervix)
Examine, Investigate: swabs, smear
Hysteroscopy
Excise and send for histology

Question 3

Cervical polyps

Answer 3

Chronic discharge
Post coital / intermenstrual bleeding
Pedunculated polyp of endocervical mucosa
Bright red ~2cm growths protruding through external os
Use polyp forceps twist to avulse if small and send for histology
large -> hysteroscopy and excision
1/6000 malignancy

Question 4

Fibroids

Answer 4

More common in nulliparous + Afro-Carribean women
Presentation: menorrhagia + intermenstrual bleeding + abdo swelling
Pressure on bladder : freq, hydronephrosis
Other: infertility, miscarriage, dyspareunia, pelvic discomfort