Postcoital bleeding: Bleeding during or after sex

Postcoital bleeding refers to bleeding associated with sexual intercourse. This bleed may occur during or after sexual intercourse. It may be a form of contact bleeding.

Some causes of postcoital bleeding are;

1. Cervical eversion
2. Cervical polyps
3. Cervicitis
4. Vaginal infections, such as trichomoniasis
5. Atrophic vaginitis
6. Coital laceration
7. Cervical cancer
   
   Brief explanation for the causes of postcoital bleeding;

• Cervical Eversion also called Cervical Ectropion– refers to a benign condition where the glandular cells that are inside the cervical canal are exposed to the outer cervix, making it more prone to bleeding. Cervical Eversion is common in young women, pregnant women, and those who use hormonal contraceptives.

• Cervical Polyps – refers to benign growths on the cervix that bleeds easily, especially after intercourse. Cervical polyps are usually painless but they may cause spotting as well as increased vaginal discharge.

• Cervicitis – refers to inflammation of the cervix which is often due to infections such as chlamydia and gonorrhea and also the use of irritants like douches or tampons. Cervicitis can cause postcoital bleeding, abnormal discharge, and even pelvic discomfort.

• Vaginal Infections like Trichomoniasis- Trichomoniasis refers to a sexually transmitted infection that causes vaginal inflammation, leading to postcoital bleeding, frothy greenish discharge, and itching.

• Atrophic Vaginitis – refers to thinning and dryness of the vaginal walls due to estrogen deficiency. Estrogen deficiency is common in postmenopausal women which makes the vaginal tissue fragile and more likely to bleed after intercourse.

• Coital Laceration – refers to trauma to the vaginal walls or cervix during sexual intercourse. Coital laceration occurs in cases where there is inadequate lubrication, forceful penetration of penis into the vagina , or underlying tissue fragility.

• Cervical Cancer – refers abnormal growth of cells in the cervix, as well as growth of fragile blood vessels in the cervix. Other symptoms associated with cervical cancer include irregular bleeding, pelvic pain, and unusual vaginal discharge.

Treatment of Postcoital Bleeding

Treatment of postcoital bleeding depends on the underlying cause:

1.Cervical Eversion (Ectropion)
If it is asymptomatic then no treatment is needed but if bleeding persists options for treating includes cauterization using cryotherapy, silver nitrate or electrocautery.

2.Cervical Polyps
Removal of the polyp by Polypectomy is done in a clinic using forceps. If the polyp is large or suspicious, histological examination is necessary to make sure they are not cancerous.

3.Cervicitis
Since it is an infection antibiotics for bacterial infections are used to treat it examples include, azithromycin or doxycycline for chlamydia; ceftriaxone for gonorrhea. Antiviral therapy is done if infection is due to herpes simplex virus, acyclovir is then used to treat. Avoiding irritants like douches or perfumed products in attempt to clean the vagina.

4.Atrophic Vaginitis
To treat atrophic vaginitis topical estrogen therapy is done using vaginal creams, rings, or tablets that content estrogen. Use of lubricants and moisturizers to reduce friction during sexual intercourse.

5.Coital Laceration
Usually minor tears heal on their own but severe tears need to be examine by a doctor and sutured. Again avoid intercourse until lacerations are healed. Avoid rough sex and make use of lubricants

6.Cervical Cancer
Cervical cancer treatment depends on the stage the cancer is in.
A. Early-stage: perform surgery (cone biopsy, hysterectomy).
B. Locally advanced: Chemoradiation.
C. Metastatic disease: Palliative care with chemotherapy or targeted therapy.

7.Vaginal Infections (e.g., Trichomoniasis)
Give Metronidazole (2g single dose or 500 mg BID for 7 days) or Tinidazole. Then treat sexual partners to prevent reinfection by the organism.

General Measures to take note of;

• Avoid sexual intercourse until the underlying cause of the postcoital bleeding is treated.

• Follow up must be done for persistent or recurrent bleeding.

• Screening with Pap smears and HPV testing ro enable early detection of cervical abnormalities.

Thank you

Sources of images

1. https://www.vejthani.com/2020/08/postcoital-bleeding-might-be-a-sign-of-cervical-cancer/
2. https://youtube/yUwZ330DKVI?si=BfdxAIIbqYWQsicF
3. https://www.verywellhealth.com/cervical-ectropion-overview-3522327
4. https://slideplayer.com/slide/5759702/
5. https://www.toplinemd.com/fern-f-taisenchoy-bent-md/news/why-do-i-bleed-after-sex/