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Postcoital Bleeding

Definition:

Non-menstrual bleeding that occurs immediately after sexual intercourse

Women with ONLY postcoital bleeding (PCB) should be seen in the colposcopy department.

Women with MIXED abnormal bleeding, such as PCB with intermenstrual bleeding (IMB), should be seen in the Menstrual Disorders clinic..

If the cervix looks suspicious on examination (see link below) refer under 2WW suspected cancer referral system

http://www.womens-health-advice.com/photos/cervical.html#stages

 

 

Information to include in referral letter 

  • Describe problem and length of symptoms
  • Current contraception
  • Any current other hormonal treatment
  • Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the consultation 
  • Relevant past medical / surgical history if not on proforma
  • Current regular medication if not on proforma
  • Speculum findings (eg normal / ectropion / cervicitis / cervical polyp)

Investigations prior to referral

  • Chlamydia screening (needs to be up-to-date, whether high risk or not)
  • High Vaginal Swab
  • NB: DO NOT perform a cervical smear if patient is outside the screening programme

Red Flag Symptoms

  • Suspicious cervix on examination
  • Postmenopausal Bleeding (PMB) i.e. bleeding >12 months after last period
  • Persistent Intermenstrual bleeding (IMB) in women in late 40’s