Postcoital bleeding

Specialty: Gynecology and breast.

• sinusrrhage
• vaginal bleeding after intercourse
• post-sexual bleeding

Why it occurs

• Acute infectious cervicitis (inflammation of the cervix due to Chlamydia trachomatis, Neisseria gonorrhoeae or Trichomonas vaginalis, which makes the cervical mucosa friable)
• Endocervical polyp (benign protuberance of the canal that protrudes from the external cervical os and bleeds from the direct mechanical friction of intercourse)
• Cervical ectropion or ectopia (presence of endocervical columnar epithelium in the exocervix, very friable, extremely common in adolescents, pregnant women and users of hormonal contraceptives)
• Cervical cancer (the neoplasia infiltrates the stromal vessels, making them fragile and prone to traumatic rupture upon contact)
• Severe vulvovaginal atrophy (thinning of the vaginal mucosa due to postmenopausal hypoestrogenism that causes microtears and fissures during penetration)

Initial workup

Comprehensive gynecological examination with placement of a speculum under good lighting to directly visualize the exocervix and vaginal walls; cervical cytology in liquid medium and molecular detection test for human papillomavirus (HPV); vaginal and cervical smear for culture and multiplex PCR of sexually transmitted pathogens; colposcopy with directed biopsy of suspicious areas if the cytology or HPV test is pathological or if a macroscopic exocervical lesion is observed.

Standard management

• Ceftriaxone — 500 mg intramuscularly in a single dose) administered together with Doxycycline (100 mg every 12 hours orally for 7 days; empirical antibiotic therapy regimen if acute infectious cervicitis due to STD is suspected
• Conjugated estrogens in vaginal cream or topical Estriol — apply locally 2-3 times a week to restore vaginal epithelial trophism in case of proven postmenopausal atrophy
• Chemical cauterization with silver nitrate or cryotherapy of cervical ectropion if it causes limiting recurrent postcoital bleeding.