Post-coital bleeding

Question 1

PCB - causes

Answer 1

1. Chlamydia
2. Gonorrhoea
3. PID
4. Cervical cancer, cervical polyp
5. Cervical ectropion

Question 2

PCB - hx

Answer 2

1. Confirm that bleeding is occurring during or after coitus
2. Determine whether there are symptoms suggestive of abnormal uterine rather than cervical bleeding (menorrhagia, irregular menstrual cycles, intermenstrual bleeding in absence of coitus)
3. AUB can be caused by a wide variety of local and systemic diseases or related to drugs - COCP/POP/IUD, HRT, anticoagulants, tamoxifen, corticosteroids
4. Signs/symptoms suggestive of infection - pain, dyspareunia, vaginal discharge, dysuria, recent change in sexual partner or symptoms in partner
5. When was the last cervical screening test and what was the result?

Question 3

PCB - examination

Answer 3

1. Visual inspection and manual examination of cervix to look for possible sources of bleeding (5) - ectropion, polyps, cervicitis, neoplasia, prolapse

Question 4

PCB - ix

Answer 4

1. STI screen for women with risk factors
2. Colposcopy and biopsy in women with grossly visible lesion or suspected cancer
3. If work-up does not reveal a cause of PCB and the bleeding persists or occurs at other times (e.g. intermenstrually), the endometrial cavity (e.g. hysterosonogram, biopsy) is evaulated to look for endometrial pathology (e.g. polyp)