Post Coital Bleeding

Original article by Tom Leach | Last updated on 4/5/2014
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Causes

Infection
Chlamydia, gonorrhoea, trichomoniasis (rarer cause)
  • Risk factors – ask about partners (number of partners, protection, Hx of sexually transmitted infection etc)
  • Ask about other symptoms –discharge, pain

Cervical / endometrial polyps

  • May be palpable on bimanual
  • Likely visible on speculum
  • Could ask patient if she has felt anything unusual
  • On examination – smooth red/purple growths that arise from the os. Usually painless, and can be easily removed.

Vaginal Cancer

  • Likely to be older

Cervical Cancer

  • Likely to be an older patient, but may be as young as mid/late twenties
  • Ask about smears
  • May cause bloody discharge
  • On examination – often a firm lump that will exhibit contact bleeding

Trauma / ectropion

Rare causes:

 

History Taking

  • Where is the bleeding coming from? – might seem a silly question, but sometimes it may be coming from the rectum or the urinary system. Any doubt can be solved by using a tampon at the time of bleeding to asses to location.
  • Periods – normal? Heavy? Absent? Any change recently?
  • Contraception what is she using?