Worried about Bleeding after Intercourse?
Post coital bleeding or PCB is defined as spotting or bleeding following intercourse that is unrelated to menstruation. Among women under the age of 35, chlamydial infection is the most important factor to exclude, while cervical cancer is the most important factor to exclude in women above the age of 35.
What causes PCB?
Often there is no explanation as to why you bleed after sexual intercourse. However, there can be a number of very common causes for this type of bleeding, these are:
- Infections
- Polyps – non cancerous growths in the uterus (womb) or on the cervix (neck of the womb)
- Vaginal dryness (common in menopausal women)
- Vaginal Trauma (common in menopausal women)
- Cervical ectropion (normal and harmless cells that line the inside of the cervical canal, these are found on the outside of the cervix)
- Abnormal cells on the cervix (pre-cancer)
- Cervical or vaginal cancer (very rare)
What can I expect when I attend the clinic?
You will be asked some general questions about your health and some more specific questions about the bleeding.
Attending your appointment, what happens?
It would be extremely helpful if you could provide the date of your last period, what contraception method you use, any allergies, and the names of any medications you take at your appointment. Your privacy will be maintained by being taken to a separate and private room to undress, where a gown will be provided. Then you will lie down on a special couch with leg supports after removing your clothes from the waist down.
We use a speculum to take a cervical sample or swabs. We may also need to take a small biopsy (sample of tissue) from the cervix or from inside your uterus. We may also use a colposcope (similar to a microscope) which is an instrument that magnifies the cervix and allows the cervix to be seen more closely. It does not enter the vagina. An ultrasound scan may be ordered following an examination based on their findings.
How do I get my results and how long will this take?
Once the results are available, we will write to you and your GP. In most cases, we can send you the results within a week of receiving all the tests. Should any further treatment or assessment be needed, we will send you a follow-up appointment.
You will be asked to collect an antibiotic prescription from your GP or our clinic if you have an infection. Alternatively, I may recommend that you see a Genito-Urinary Medicine (GUM) specialist.
Is there anything to look out for when I go home?
This will depend on the treatment or investigations you have carried out on that day. We will discuss this with you before you are discharged.
What is cervical ectropion?
Cervical ectropion (or erosion) is a red and raw-looking area on the outside of the cervix (womb's neck). There is no need to worry about this condition since it is common and harmless. The condition has no link to cervical cancer. An ectropion occurs when glandular cells are visible on the outside of the cervical canal (cervical ectropion). A glandular cell's fragility makes it prone to trauma during sexual activity.
How do you get cervical ectropion?
Hormonal changes, pregnancy, and oral contraceptive pill use can lead to cervical ectropion. This is visible with a speculum examination. In the majority of cases, cervical ectropion does not cause any problems and may resolve on its own over time. The condition may cause unexpected vaginal bleeding, spotting, or blood stained vaginal discharge in some women, particularly during or following sexual activity. Seek medical advice if you experience persistent abnormal bleeding.
What if I’m pregnant?
During pregnancy, cervical ectropion is very common. Pregnant women are more likely to experience symptoms due to hormonal changes and high levels of estrogen in their body. Although these changes are common, any unusual discharge or bleeding in pregnancy should be investigated by your GP, midwife, early pregnancy unit or maternity triage depending on the stage of your pregnancy to ensure there is no other cause of the bleeding.
What treatments are available?
Symptoms can usually resolve on their own within 3-6 months without treatment. Changing from a combined pill to a different contraception can sometimes alleviate cervical ectropion. However, if your symptoms persist for more than 6 months, treatment might be necessary.
Treatment is usually performed at a colposcopy clinic. The treatment works by destroying the delicate cells to prevent them from bleeding, although it is not recommended during pregnancy. Different treatment options are available, such as
Silver nitrate - This involves superficial cauterization (burning) of the ectropion. Local anaesthesia is usually not required.
Cold coagulation - This involves cauterising the ectropion with a hot metal probe for 30-60 seconds. This is performed using local anaesthetic.
Diathermy - This uses an electric current to cauterise the ectropion. It is performed under local anaesthetic. It is normal to experience a ‘period like pain’, mild vaginal bleeding and discharge after treatment. It may last for 1-4 weeks. To reduce the risk of infection, avoid using tampons, penetrative intercourse, and swimming until the bleeding and discharge have completely settled.
If you experience any of these symptoms after treatment, you should seek medical attention:
A smelly discharge
Fever or high temperature
Heavy vaginal bleeding
Severe abdominal pain
It is important to note that treatment does not always resolve symptoms completely, and any improvement may be temporary.
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