Summary
Postcoital bleeding is vaginal bleeding after intercourse, ranging from light spotting to heavier flow. It is often painless and may be associated with irregular or intermenstrual bleeding. Common causes include vaginal trauma, atrophy, infections, polyps, or malignancy; minor causes involve friction or contraceptive devices. Diagnosis involves pelvic exam, Pap smear, imaging, and STI testing. Treatment depends on the cause and may include lubricants, antibiotics, hormone therapy, surgical removal of lesions, or cancer treatment.
Definition
Postcoital bleeding refers to vaginal bleeding that occurs after sexual intercourse involving vaginal penetration. This symptom may range from light spotting to heavier bleeding and can be caused by a wide range of benign or serious conditions affecting the cervix, vagina, or uterus.
Clinical Presentation
- Bleeding: Occurs shortly after vaginal intercourse, bright red or brown in color, may be minimal (light spotting) or heavy enough to soak clothing or bedding, can last from a few hours to several days.
- Pain: Often painless, only ~15% report dyspareunia (pain during or after intercourse).
- Associated symptoms: Approximately 30% also experience other abnormal uterine bleeding patterns, such as:
- Intermenstrual bleeding (bleeding between periods).
- Irregular menstrual cycles.
Common Causes
The most frequent etiologies of postcoital bleeding are localized to the genital tract, including:
- Vaginal trauma or lacerations
- Vaginal atrophy (particularly in postmenopausal individuals)
- Infectious causes (e.g., vaginitis, cervicitis)
- Inflammatory conditions
- Cervical polyps
- Cervical ectropion
- Malignancy (e.g., cervical or vaginal cancer)
Minor Causes
- Friction-related trauma: Due to inadequate vaginal lubrication during intercourse.
- Mechanical irritation: From contraceptive devices, such as:
- Intrauterine devices (IUDs)
- Cervical caps or diaphragms
- Common in younger individuals and premenopausal women.
Diagnostic Evaluation
Investigations may include:
- Pap smear for cervical cytology
- Colposcopy to examine the cervix under magnification
- Biopsy of any suspicious lesions
- Transvaginal ultrasound to assess the endometrium and uterus
- STI screening
- Blood tests, particularly if systemic causes are suspected
Management
| Treatment Approach | Indication / Description |
|---|---|
| Vaginal lubricants | Reduces friction during intercourse; prevents minor trauma |
| Topical estrogen or hormone therapy | Treats vaginal atrophy, particularly in postmenopausal women |
| Antibiotics | Used for infectious causes such as cervicitis or vaginitis |
| Topical corticosteroids | For dermatologic conditions like lichen sclerosus |
| Surgical intervention | Removal of benign lesions (e.g., polyps) or treatment of malignant tumors |
| Cancer-specific therapy | For confirmed malignancies; may include chemotherapy, radiation, or surgery |
| Lifestyle modifications | Weight loss and smoking cessation, especially when hormonal imbalance is a contributing factor |
| Pelvic floor exercises (e.g., Kegel exercises) | May be beneficial in cases of genitourinary syndrome of menopause or pelvic organ prolapse |
احصل على التجربة الكاملة
اشترك للوصول لفيديوهات الشرح التفصيلي والبطاقات التعليمية التفاعلية وأسئلة الممارسة مع تتبع التقدم.