Postcoital Bleeding

Introduction

• Description: Postcoital bleeding is vaginal bleeding that occurs following sexual intercourse.

• Prevalence: Common (5%–10% women per year, up to 13% of women 20–34 years old).

• Predominant Age: Reproductive age and beyond.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Uterine (pregnancy, endometrial polyps, endometrial hyperplasia, endometrial carcinoma, leiomyomata, intrauterine contraceptive device [malpositioned]), cervical (polyps [5%–18% of cases], cervicitis [ Chlamydia cervicitis 2%], cervical erosion [ectropion, 34% of cases], cervical dysplasia or neoplasia [7%–17% of cases]), vaginal (trauma, infection, atrophy), and perineal (urethral, vulvar lesions, hemorrhoids).

• Risk Factors: Hypoestrogenic states (menopause without estrogen therapy), vigorous intercourse, and nonconsensual intercourse (rape).

Signs and Symptoms

• Painless vaginal bleeding related to (after) intercourse.

Diagnostic Approach