Postcoital bleeding

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Postcoital bleeding
Blausen 0399 FemaleReproSystem 01.png
SpecialtyGynecology
SymptomsVaginal bleeding after sex[1]
Usual onsetReproductive age and older[2]
CausesCervical ectropion, cervical or endometrial polyps, infections including sexually transmitted infection, injury, pregnancy, vaginal atrophy, cervical or endometrial cancer[2][1]
Risk factorsLow estrogen, sexual assault, vigorous sex[2]
Diagnostic methodBased on examination, pregnancy testing, taking swabs[2]
TreatmentDepends on cause[2]
Frequency5%-10% of females[2]

Postcoital bleeding (PCB) is vaginal bleeding after sexual intercourse that is not related to menstruation.[1] While typically painless, in about 15% of cases pain is present.[2] Often those affected also have abnormal uterine bleeding including intermenstrual bleeding.[2][1]

Before menopause common causes include cervical ectropion (33%), cervical or endometrial polyps (5% to 18%), infections including sexually transmitted infection, injury, and pregnancy.[2][1] After menopause the most common cause is vaginal atrophy.[2][1] It may also be an early signs of cervical or endometrial cancer (7 to 17% of cases).[2] Other causes include endometriosis and a malpositioned intrauterine device.[1][2] Diagnosis involves examination of the vagina and cervix, pregnancy testing, taking swabs, and sometimes a biopsy.[3][2] Other tests may include ultrasound, Pap smear, and colposcopy.[1]

Treatment depends on the cause.[2] Silver nitrate may be used to treat cervical ectropion, while cervical polyps can be removed.[1] In more than half of people without a clear cause, symptoms resolve within six month.[1] Referral is recommended to a gynecologist if the condition persists beyond this.[1] Postcoital bleeding is common, affected around 5% to 10% of females.[1][2] Due to the association with sexual assault, this should be asked about.[1]

Causes

Blood may be seen after sex following the first time a female has intercourse; the hymen is thin and may bleed when stretched.[4][failed verification] Other activities may have an effect on the vagina such as sports and tampon use.[4] Postcoital bleeding may stop without treatment.[5] In some instances, postcoital bleeding may resemble menstrual irregularities.[6] Postcoital bleeding may occur throughout pregnancy. The presence of cervical polyps may result in postcoital bleeding during pregnancy because the tissue of the polyps is more easily damaged.[7] Postcoital bleeding can be due to trauma after consensual and non-consensual sexual intercourse.[8][9]

Vaginal bleeding after sex is a symptom that can indicate:

Bleeding from hemorrhoids and vulvar lesions can be mistaken for postcoital bleeding.[9] Post coital bleeding can occur with discharge, itching, or irritation. This may be due to Trichomonas or Candida.[11] A lack of estrogen can make vaginal tissue thinner and more susceptible to bleeding. Some have proposed that birth control pills may cause postcoital bleeding.[14]

Risk factors for developing postcoital bleeding are: low estrogen levels, rape and 'rough sex'.[9]

Diagnosis and treatment

Tests and detailed examination are used to determine the cause of the bleeding:

A referral may be made to a specialist.[10][15] Imaging may not be necessary. Cryotherapy has been used but is not recommended.[9]

Epidemiology

Postcoital bleeding rarely is associated with gynecological cancer in young women and its incidence is projected to drop due to the widespread immunizations against HPV. Postcoital bleeding has been most studied in women in the US. In a large Taiwanese study, the overall incidence of postcoital bleeding was found to be 39-59 per 100,000 women. Those with postcoital bleeding had a higher risk of cervical dysplasia and cervical cancer. Benign causes of postcoital bleeding were associated with cervical erosion, ectropion, vaginitis and vulvovaginitis. Other associations were noted such as the presence of leukoplakia of the cervix, an intrauterine contraceptive device, cervical polyps, cervicitis, menopause, dyspareunia, and vulvodynia.[16] In Scotland approximately 1 in 600 women aged 20–24 experience unexplained bleeding.[14] A study of African women found that trauma from consensual sexual intercourse was a cause of postcoital bleeding in young women.[17]

Society and culture

Hymenorrhaphy is a controversial procedure to surgically repair a damaged hymen, thus restoring the appearance of virginity:

"From a Western-ethics perspective, the life-saving potential of the procedure is weighed against the role of the surgeon in directly assisting in a deception and in indirectly promoting cultural practices of sexual inequality. From an Islamic bioethical vantage point, jurists offer two opinions. The first is that the surgery is always impermissible. The second is that although the surgery is generally impermissible, it can become licit when the risks of not having postcoital bleeding harm are sufficiently great."[18]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Ardestani, Shakiba; Dason, Ebernella Shirin; Sobel, Mara (11 September 2023). "Postcoital bleeding". Canadian Medical Association journal. 195 (35): E1180. doi:10.1503/cmaj.230143. ISSN 1488-2329. PMC 10495171. PMID 37696551. {{cite journal}}: Check |pmc= value (help)
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 Smith, Roger P. (2023). "60. Postcoital bleeding". Netter's Obstetrics and Gynecology: Netter's Obstetrics and Gynecology (4th ed.). Philadelphia: Elsevier. pp. 139–140. ISBN 978-0-443-10739-9. Archived from the original on 2023-10-31. Retrieved 2023-10-31.
  3. Japp, Alan; Robertson, Colin (2018). "33. Vaginal bleeding". Macleod's Clinical Diagnosis (2nd ed.). Edinburgh: Elsevier. pp. 288–293. ISBN 978-0-7020-6962-8. Archived from the original on 2023-11-01. Retrieved 2023-11-01.
  4. 4.0 4.1 Choices, N. H. S. (2016-07-12). "Does a woman always bleed when she has sex for the first time? - Health questions - NHS Choices". Archived from the original on 2013-05-07. Retrieved 2018-02-04.
  5. Shapley, M; Blagojevic-Bucknall, M; Jordan, Kp; Croft, Pr (2013-10-01). "The epidemiology of self-reported intermenstrual and postcoital bleeding in the perimenopausal years". BJOG: An International Journal of Obstetrics & Gynaecology. 120 (11): 1348–1355. doi:10.1111/1471-0528.12218. ISSN 1471-0528. PMID 23530690. S2CID 25418515.
  6. Halpern, Vera; Raymond, Elizabeth G; Lopez, Laureen M (2014). "Repeated use of pre- and postcoital hormonal contraception for prevention of pregnancy". Cochrane Database of Systematic Reviews. 2014 (9): CD007595. doi:10.1002/14651858.cd007595.pub3. PMC 7196890. PMID 25259677.
  7. J., Cibulka, Nancy (2013). Guidelines for nurse practitioners in ambulatory obstetric settings. Barron, Mary Lee. New York: Springer Publishing Company. p. 240. ISBN 9780826195579. OCLC 841914663.
  8. Boukhanni, Lahssen; Dhibou, Hanane; Zilfi, Wafaa; Housseini, Kawtar Iraki; Benkeddour, Yasser Ait; Aboulfalah, Abderrahim; Asmouki, Hamid; Soummani, Abderraouf (2016). "Les hémorragies post coïtales: à propos de 68 cas et revue de littérature". Pan African Medical Journal (in français). 23: 131. doi:10.11604/pamj.2016.23.131.9073. PMC 4885701. PMID 27279958.
  9. 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Smith, Roger P. (2017-02-16). Netter's Obstetrics and Gynecology E-Book. Elsevier Health Sciences. ISBN 9780323523509. Archived from the original on 2023-10-20. Retrieved 2023-05-28.
  10. 10.0 10.1 10.2 10.3 10.4 10.5 10.6 Choices, N. H. S. (2018). "What causes a woman to bleed after sex? - Health questions - NHS Choices". Archived from the original on 2018-02-05. Retrieved 2018-02-04.
  11. 11.0 11.1 11.2 11.3 "Postcoital Bleeding in a Premenopausal Patient". www.medscape.com. Archived from the original on 2002-04-15. Retrieved 2018-02-04.
  12. Walker, Brian R.; Colledge, Nicki R. (2013-12-06). Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences. ISBN 9780702051036. Archived from the original on 2023-10-20. Retrieved 2023-05-28.
  13. Drake, William M.; Hutchison, Robert (2012-01-01). Hutchison's Clinical Methods, An Integrated Approach to Clinical Practice With STUDENT CONSULT Online Access,23: Hutchison's Clinical Methods. Elsevier Health Sciences. ISBN 978-0702040917. Archived from the original on 2023-10-20. Retrieved 2023-05-28.
  14. 14.0 14.1 Health, Department of (2010-03-03). "Clinical practice guidelines for the assessment of young women aged 20-24 with abnormal vaginal bleeding". Archived from the original on 2010-11-10. Retrieved 2018-02-04.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  15. "Postcoital bleeding". Royal College of Obstetricians & Gynaecologists. Archived from the original on 2020-01-28. Retrieved 2018-02-05.
  16. Liu, Hsin-Li; Chen, Chuan-Mei; Pai, Lee-Wen; Hwu, Yueh-Juen; Lee, Horng-Mo; Chung, Yueh-Chin (2017-04-01). "Comorbidity profiles among women with postcoital bleeding: a nationwide health insurance database". Archives of Gynecology and Obstetrics. 295 (4): 935–941. doi:10.1007/s00404-017-4327-7. ISSN 0932-0067. PMID 28246983. S2CID 8994475.
  17. Boukhanni, Lahssen; Dhibou, Hanane; Zilfi, Wafaa; Housseini, Kawtar Iraki; Benkeddour, Yasser Ait; Aboulfalah, Abderrahim; Asmouki, Hamid; Soummani, Abderraouf (2016-03-25). "Les hémorragies post coïtales: à propos de 68 cas et revue de literature". The Pan African Medical Journal. 23: 131. doi:10.11604/pamj.2016.23.131.9073. PMC 4885701. PMID 27279958.
  18. Bawany, Mohammad H.; Padela, Aasim I. (August 2017). "Hymenoplasty and Muslim Patients: Islamic Ethico-Legal Perspectives". The Journal of Sexual Medicine. 14 (8): 1003–1010. doi:10.1016/j.jsxm.2017.06.005. PMID 28760245.

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