EpistemisPostcoital vaginal bleeding
Specialty: Gynecology and breast.
Why it occurs
- Cervical ectropion (erosion or eversion of the endocervical mucosa, very sensitive to friction)
- Cervical polyp
- Acute cervicitis (infectious due to Chlamydia trachomatis, Neisseria gonorrhoeae or Trichomonas vaginalis)
- Atrophic vaginitis (common in menopause due to epithelial fragility)
- Squamous cell carcinoma of the cervix (more serious cause that should always be ruled out)
Initial workup
Immediate gynecological examination with a speculum under direct vision of the cervix. Taking cervical cytology (Pap smear) and typing of the Human Papillomavirus (HPV). Cervical smear for Chlamydia, Gonococcus and Mycoplasma PCR. Colposcopy with targeted biopsy of any acetowhite lesions, abnormal Lugol uptake (Schiller positive), or suspicious atypical vessels.
red flags
Persistent or recurrent postcoital bleeding, presence of an exophytic, ulcerated or stony mass visible in the cervix using a speculum, fetid purulent or watery vaginal discharge ("meat washing water"), persistent deep dyspareunia, weight loss, dull lumbar or pelvic pain of recent onset.
Standard management
- There is no direct medical treatment for bleeding from structural causes; Cervical polyps should be removed by twisting and excision in office. Azithromycin 1 g orally in a single dose associated with Ceftriaxone 500 mg intramuscularly in a single dose if acute infectious cervicitis is suspected. Topical vulvovaginal conjugated estrogen creams if the cause is vaginal atrophy due to hypoestrogenism (note: in the case of any suspicious macroscopic cervical lesion, biopsy is a priority regardless of the previous cytology result).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 1