Postcoital Bleeding

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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Chapter 40 Postcoital Bleeding

INTRODUCTION

Description: Postcoital bleeding is vaginal bleeding that occurs following sexual intercourse.
Prevalence: Common.
Predominant Age: Reproductive age and beyond.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Uterine (pregnancy, endometrial polyps, endometrial hyperplasia, endometrial carcinoma, leiomyomata), cervical (polyps, cervicitis, cervical erosion, cervical dysplasia or neoplasia), vaginal (trauma, infection, atrophy), perineal (vulvar lesions, hemorrhoids).
Risk Factors: Hypoestrogenic states (menopause without estrogen replacement, vigorous intercourse, and nonconsensual intercourse [rape]).

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Painless vaginal bleeding related to (after) intercourse

DIAGNOSTIC APPROACH

Differential Diagnosis

• Pregnancy (normal or abnormal)
• Cervical polyps
• Endometrial polyps
• Uterine leiomyomata
• Cervicitis or cervical lesions (including cancer)
• Endometrial cancer
• Endometriosis
• Vaginitis (including atrophic vaginitis)
• Coagulopathy (acquired or iatrogenic)
• Nongynecologic sources of bleeding (e.g., perineal or rectal)

Associated Conditions: Endometrial cancer, endometrial polyps or carcinoma, and uterine leiomyomata.

Workup and Evaluation

Laboratory: No evaluation indicated.
Imaging: No imaging indicated.
Special Tests: None indicated.
Diagnostic Procedures: History and physical examination often point to possible causes for further evaluation.

Pathologic Findings

Based on underlying pathologic condition.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation.
Specific Measures: Focused on underlying cause.
Diet: No specific dietary changes indicated.
Activity: No restriction.
Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP095 (Abnormal Uterine Bleeding).

Drug(s) of Choice

Based on cause.

FOLLOW-UP

Patient Monitoring: Normal health maintenance.
Prevention/Avoidance: None.
Possible Complications: Sexual dysfunction (rare).
Expected Outcome: Return to normal sexual function with reassurance and correction of the causative process.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy. Slightly more common during pregnancy.
ICD-9-CM Codes: 626.7.

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REFERENCES

Level I

Bain C, Parkin DE, Cooper KG. Is outpatient diagnostic hysteroscopy more useful than endometrial biopsy alone for the investigation of abnormal uterine bleeding in unselected premenopausal women? A randomised comparison. BJOG. 2002;109:805.

Tahir MM, Bigrigg MA, Browning JJ, et al. A randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage. Br J Obstet Gynaecol. 1999;106:1259.

Level II

Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding. Radiol Clin North Am. 2003;41:769.

Shapley M, Jordan J, Croft PR. A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract. 2006;56:453.

Level III

American College of Obstetricians and Gynecologists. Diagnosis and treatment of cervical carcinomas. ACOG Practice Bulletin 35. Washington, DC: ACOG, 2002.

American College of Obstetricians and Gynecologists. Vaginitis. ACOG Practice Bulletin 72. Washington, DC: ACOG, 2006.

Cowan BD, Morrison JC. Management of abnormal genital bleeding in girls and women. N Engl J Med. 1991;324:1710.

Field CS. Dysfunctional uterine bleeding. Primary Care. 1988;15:561.

Neese RE. Managing abnormal vaginal bleeding. Postgrad Med. 1991;89:205.

Smith-Bindman R, Kerlikowske K, Feldstein VA, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA. 1998;280:1510.

Zuber TJ. Endometrial biopsy. Am Fam Physician. 2001;63:1131. 1137.

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