Postcoital bleeding

Question 1

Postcoital bleeding

Answer 1

Vaginal bleeding after sex
- pathological until proven otherwise

Question 2

Causes of postcoital bleeding

Answer 2

PREGNANCY!!

Cervical
- Red Flags TRO: Cervical CA
- Cervical Ectropion (Common)
- Cervical Polyps / Fibroids
- Cervicitis (Chlamydia/ BV)
*To do STD screen
- Previous cervical instrumentation

Vagina (rare)
- Atrophic Vaginitis (>60)
*If unable to find other reasons for >60y/o, Ix TRO endometrial CA first
*Dryness and itch
- Torn vagina/ Trauma 2° rough sex
- Genital prolapse 2° to ulcerations
- Vaginal CA (Very rare)
- Benign vascular neoplasm

Question 3

Approach to post coital bleed

Answer 3

1. Evaluate entire lower genital tract
   - Vulva
   - Perianal region
   - Vagina
   - Cervix
2. Speculum examination
   - NO lesion seen on cervix -> Do pap smear/HPV test
   *Pap/HPV test negative -> Observe
   *Abnormal Pap/HPV -> Colposcopy
   - Lesion SEEN on cervix -> Biopsy
   - Ectropian
   - Mucopurulent discharge -> Screen for STIs

Question 4

Cervical ectropion (physiological)

Answer 4

• Columnar epithelium exposed to vaginal milieu by eversion of endocervix
• Everted epithelium has a reddish appearance similar to granulation tissue
• Common and normal, can lead to contact bleeding during intercourse/ speculum/ bimanual examination

Question 5

Risk factors of cervical ectropion

Answer 5

Pregnancy
Use of OCPs