Post Coital Bleeding

Scope

Post coital bleeding is defined as bleeding that occurs after sexual intercourse.

Assessment

History and Examination

History:
  • Frequency of occurrence
  • Related to changes e.g change in contraceptive pill
  • Associated with pain?
Examination:
  • View cervix
  • Cervical smear if over 25 years old and due under the screening programme
  • Triple swab (high vaginal, endocervical and chlamydia swabs)
  • Any evidence of infection
  • View for polyps

Differential Diagnoses

  • Menstrual irregularity
  • Infection
  • Intermenstrual bleeding
  • Cervical polyps
  • Endometrial polyps
  • Cervical Cancer

Red Flags

If the cervix appears/feels abnormal/suspicious upon speculum examination, refer urgently for colposcopy (2 week wait)

Cervical cancers are rare in women of reproductive age.

Risk factors for cervical cancers include:

  • Human Papilloma Virus (HPV)
  • Previous abnormal smear result
  • Multiple sexual partners
  • Smoking

Management

Visually normal cervix/vagina
  • Normal smear result or under 25
    • Check swab results and treat as appropriate
    • If all examination and investigation findings are normal, then patient can be reassured
    • If however symptoms are particularly troublesome, consider routine referral to Gynaecology
  • Abnormal smear result
    • If Dyskaryotic smear - direct referral initiated by pathology
    • Refer to Colposcopy
Ectropion or polyp with normal smear or under 25
  • Cervical polyps may be removed in primary care
  • Ectropion is a physiological phenomenon and does not require referral unless patient suffers from persistent or annoying symptoms, consider routine referral to Gynaecology
Visually abnormal cervix/vagina

Referral

Referral Criteria

  • Consider referral to routine Gynaecology:
    • If troublesome symptoms persist after management in primary care
  • Refer to Colposcopy under 2ww:
    • If vagina or cervix appears/feels abnormal/suspicious

Referral Instructions

For referral to Gynaecology, refer via e-Referral Service:

e-Referral Service selection:

  • Speciality: Gynaecology
  • Clinic Type: Not otherwise specified
  • Service: DRSS-Eastern-Gynaecology-Devon CCG- 15N
For referral to 2ww Gynaecology, refer via e-Referral Service:
  • e-Referral Service selection:
  • Speciality: 2ww
  • Clinic Type: 2ww Gynaecology
  • Service: Two Week Wait Gynaecology-RDE-RH8

Referral Forms

DRSS Referral Proforma

2ww Gynaecology

Supporting Information

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: November 2018

 

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