Vaginal bleeding (post-coital)

Postcoital bleeding consists of spotting or bleeding that is not related to menstruation and occurs during or after sexual intercourse.

Many of the signs and symptoms suggestive of cervical cancer are common to genital Chlamydia trachomatis infection. Women who have symptoms of irregular or contact bleeding or have an inflamed or friable cervix should be tested for Chlamydia trachomatis and treated if appropriate (1)

The prevalence of PCB ranges from 0.7% to 9% of menstruating women (2) and around 8% in one UK-based study of perimenopausal women (3)

For premenopausal women who are naturally menstruating, spontaneous resolution has been documented in 51% at two years with no further signs of recurrence (4)

• about 30% of patients with postcoital bleeding also experience abnormal uterine bleeding and 15% have dyspareunia.

On average, only 2% of women seen in secondary care with post-coital bleeding have cervical cancer.

The risk of having a cervical cancer is not related to the duration and extent of symptoms (1)

It is estimated that estimate that 11% of women with cervical cancer will present with postcoital bleeding. (4) (The prevalence of cervical intraepithelial neoplasia (CIN) and cancer among women with postcoital bleeding is estimated to be 3–18%) (5)

The probability that a woman developing postcoital bleeding in the community has cervical cancer

There is evidence of the need for a cervical smear to be performed at the recommended times according to the national screening programme although there is no evidence for a role for cervical cytology in the assessment of a woman with postcoital bleeding if a cervical smear is not due (4)

Post-coital bleeding is more likely to originate from the vagina or cervix than the endometrium. This symptom is the classical symptom of cervical carcinoma. (4)

Causes include: (6)

• vaginal:
  • vaginitis
  • carcinoma - very rare
• cervix:
  • cervicitis
  • polyps
  • carcinoma - the most likely malignant cause of PCB
  • trauma - even quite minor lesions may cause severe PCB if co-existent coagulation disorder
  • ectropion

References:

1. British Gynaecological Cancer Society (BGCS) Cervical Cancer Guidelines: Recommendations for Practice (Accessed 21/10/2020).
2. Ardestani S, Dason ES, Sobel M. Postcoital bleeding. CMAJ. 2023 Sep 11;195(35)
3. Shapley M, Blagojevic-Bucknall M, Jordan KP, et al. The epidemiology of self-reported intermenstrual and postcoital bleeding in the perimenopausal years. BJOG. 2013 Oct;120(11):1348-55
4. Shapley M, Jordan J, Croft PR. A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract 2006;56(527):453-60.
5. Tarney CM, Han J. Postcoital bleeding: a review on etiology, diagnosis, and management. Obstet Gynecol Int 2014;2014:192087.
6. Owens G et al. Investigation and management of postcoital bleeding. The Obstetrician & Gynaecologist. 2022;24:24–30