Postcoital_Bleeding_Flashcards

Question 1

What is postcoital bleeding?

Answer 1

Postcoital bleeding describes vaginal bleeding after sexual intercourse.

Question 2

In what percentage of cases is no identifiable pathology found for postcoital bleeding?

Answer 2

No identifiable pathology is found in around 50% of cases.

Question 3

What is the most common identifiable cause of postcoital bleeding?

Answer 3

Cervical ectropion, causing around 33% of cases. It is more common in women on the combined oral contraceptive pill.

Question 4

What are other causes of postcoital bleeding?

Answer 4

Cervicitis (e.g., secondary to Chlamydia), cervical cancer, polyps, trauma.

Question 5

A woman presents to her GP complaining of bleeding after sexual intercourse. What is the most common identifiable cause of postcoital bleeding?

• Cervical ectropion
• Cervical cancer
• Cervical polyps
• Vaginal trauma
• Cervicitis secondary to Chlamydia

Answer 5

Cervical ectropion

Cervical ectropion is the most common identifiable cause of postcoital bleeding

The correct answer is Cervical ectropion. Cervical ectropion, also known as cervical erosion, is the most common identifiable cause of postcoital bleeding. It involves the eversion of the endocervical columnar epithelium onto the ectocervix, which can lead to an increased susceptibility to trauma and hence bleeding after intercourse. This condition is particularly common in women of reproductive age and those taking oral contraceptives.

Cervical cancer is a less common cause of postcoital bleeding but it’s important to consider due to its serious implications. However, other symptoms such as irregular menstrual cycles, pelvic pain or unexplained weight loss often accompany this diagnosis. Therefore, while it must be ruled out in any woman presenting with postcoital bleeding, it’s not the most common cause.

Similarly, cervical polyps can cause postcoital bleeding but they are not as common as cervical ectropion. These benign growths on the cervix can become irritated and bleed following intercourse. However, they often present asymptomatically and are usually discovered during routine gynaecological examinations.

Vaginal trauma could potentially cause bleeding after sexual activity if there was significant force involved or if there were pre-existing lesions in the vagina that were disturbed. However, this would typically be associated with pain and discomfort during intercourse rather than isolated bleeding afterwards.

Finally, cervicitis secondary to Chlamydia infection could indeed result in postcoital bleeding due to inflammation of the cervix. Nevertheless, other symptoms such as abnormal vaginal discharge or lower abdominal pain would usually be present too. Additionally, sexually transmitted infections including Chlamydia are more likely to cause intermenstrual rather than postcoital bleeding.