Management of Postcoital Bleeding Underlying causes of post Click for more in Primary Care coital bleeding info Images of normal, benign and malignant cervical pathology RED FLAGS · Suspicious looking cervix Casey et al. Abnormal Cervical Appearance: What to Do, When to Worry?: Mayo Clin Proc. 2011 Feb; History and Examination · Suspicious vulval lesion 86(2): 147–151. https://www.ncbi.nlm.nih.gov/pmc/ Click for · Suspicious Vaginal mass articles/PMC3031439/ more · Post coital haemorrhage info TThhee BBrriittiisshh SSoocciieettyy ffoorr CCoollppoossccooppyy aanndd CCeerrvviiccaall Pathology: https://www.bsccp.org.uk Pathology: https://www.bsccp.org.uk Click for Investigations more info Refer urgently to specialist care on suspected cancer pathway Findings Ectropion Cervical Polyp Positive infection screen Normal cervix and · Can be removed in primary care · · The cause is hormonal Treat based on local sensitivities negative infection screen · May resolve spontaneously if the setting · Contact tracing COCP is stopped or following · Send for histology · Review in 12 weeks pregnancy · If unable to remove in primary · Refer to gynaecology clinic if · Review in 10-12 weeks care refer to gynae clinic persisting despite adequate Review after 6 weeks · If persistent refer to gynae clinic treatment If still bleeding refer to general gynaecology If unresolved - General Gynaecology clinic Back to Underlying causes of post coital bleeding: pathway · Infection · Cervical ectropion - especially in those women taking the combined oral contraceptive pill (COCP) · Cervical or endometrial polyps. · Vaginal cancer · Cervical cancer - usually apparent on speculum examination. · Trauma Post coital bleeding in post-menopausal women should be managed as post-menopausal bleeding. Back to History and Examination pathway The history should aim to determine with the cause is likely benign or malignant. This should include: · Duration, frequency and severity of symptoms · Current contraception · Any current other hormonal treatment (e.g. HRT) · Smear History: regular, irregular, including date and result of last smear · Details of any previous colposcopy, any treatments such as LLETZ/cold coagulation/laser · Sexual History (if appropriate) · Relevant past medical/surgical history (including haematological/ coagulation disorders) · Current regular medication Conduct a bimanual and speculum examination and note the findings (e.g. normal, ectropion, cervicitis, cervical polyp). Refer to online resource below for images of typical examination findings Back to Investigations: pathway Always exclude the possibility of pregnancy and STI as a cause of bleeding: · Pregnancy test · Infection screen – Chlamydia and Gonorrhoeae. Cervical smears should only be taken where a women is due or overdue for her regular screening.