Persistent postcoital uterine bleeding

Specialty: Gynecology and breast.

• refractory postcoital bleeding
• chronic sinus bleeding

Why it occurs

• Advanced cervical cancer (invasive neoplasm that destroys the stromal vessels of the cervix, making them extremely fragile to any friction or mechanical contact during intercourse)
• Giant friable cervical ectropion (presence of columnar epithelium outside its normal location, very friable, with exposed vessels that bleed repeatedly after sexual intercourse)
• Chronic persistent cervicitis due to Chlamydia or high-risk HPV (with severe inflammation and cellular infiltrate that weakens the cervical epithelium)
• Giant fibroepithelial cervical polyp (large benign pedunculated lesion that undergoes ulceration and bleeding due to repeated coital trauma)
• Severe senile vaginal atrophy with narrowing of the vaginal canal

Initial workup

Comprehensive gynecological examination with speculum under good lighting; cervical cytology and molecular testing for high-risk human papillomavirus (HPV); detailed colposcopy with biopsy of suspicious areas (of choice); MRI of the pelvis if neoplastic pathology is confirmed to evaluate parametrial or lymph node extension.

Standard management

• Specific oncological treatment — non-regular pharmacological, surgery or radiotherapy/chemotherapy in case of cervical cancer
• Cryotherapy or chemical cauterization with silver nitrate of benign friable lesions or symptomatic giant ectropions
• Conjugated estrogens in local vaginal cream (if associated with severe postmenopausal vaginal atrophy as an adjuvant).