The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding

Abstract

Objectives To document the frequency of pathology in women who complain of postcoital bleeding. To determine whether negative cervical cytology excludes serious pathology in women with postcoital bleeding. To determine whether postcoital bleeding increases the risk of serious pathology in women with an abnormal smear.Design A retrospective study.Setting A university teaching hospital. Population 314 women with postcoital bleeding seen in the gynaecology service from ®rst January 1988 to 31 December 1994. Methods Women were identi®ed from the computerised records of the colposcopy service and copies of correspondence, which was routinely retained on computer. The latter was searched for the text strings coital and intercourse. Main outcome measure Histopathological diagnosis.Results Twelve women (4%) had invasive cancer: 10 were cervical or vaginal cancers and two endometrial cancers. Eight of the 10 cervical or vaginal cancers were clinically apparent. Four women of these 10 had had a normal smear before being referred for further investigation of postcoital bleeding. Two of these cancers were visible only with the aid of the colposcope. Thus, 0.6% of women attending a gynaecology service with postcoital bleeding, a normal looking cervix and a normal smear had invasive cancer of the cervix. Cervical intraepithelial neoplasia were found in 54 women (17.%) and 15 women (5%) had cervical polyps. Nineteen of the 63 women (30%) with signi®cant pathology had a normal or in¯ammatory cervical smear. No explanation for the postcoital bleeding was found in 155 women (49 %).Conclusions Although invasive cancer is rare in women with postcoital bleeding, it is much commoner than in the general population. It seems likely that cervical intraepithelial neoplasia is also associated with postcoital bleeding, perhaps because the fragile cervical epithelium becomes detached during intercourse. Postcoital bleeding should continue to be regarded as an indication of high risk for invasive cervical cancer and for cervical intraepithelial neoplasia. Prompt referral to a colposcopy clinic is indicated, but most women with postcoital bleeding will have no serious abnormality.

Evaluation of women with postcoital bleeding by clinical examination, papsmear, colposcopy and histopathology of cervix

“…16 Shalini R et al reported that 5.5% of women with postcoital bleeding had invasive cancer cervix in their study whereas Rosenthal AN et al reported 4% cases with invasive cancer cervix. 8,9 Allen et al reported that 1% of women with postcoital bleeding had carcinoma cervix in their study and Ashrafgangoei T et al reported 1.8% cases with invasive cancer cervix in women with postcoital bleeding in their study. 19 Sensitivity of papsmear was 71.42%, specificity-86.20%, PPV-78.95%, NPV-80.64% and accuracy-80% in present study.…”

“…5 The prevalence of cervical cancer in women with post coital bleeding is 3-5.5% and prevalence of CIN is 6.8-17.8%. [6][7][8][9][10] Cervical cancer is the second most common cancer in the women throughout the world.…”

“…5 The prevalence of cervical cancer in women with post coital bleeding is 3-5.5% and prevalence of CIN is 6.8-17.8%. [6][7][8][9][10] Cervical cancer is the second most common cancer in the women throughout the world.Cervical cancer kills approximately 2,30,000 women annually and the vast majority of deaths occur in developing countries. Carcinoma cervix is the 5th most ABSTRACT Background: Postcoital bleeding refers to spotting or bleeding per vagina that occurs after intercourse and is not related to menstruation.…”

Therapeutic Effectiveness of Large Loop Excision of Transformation Zone (LLETZ) in Management of Cervical Lesions

“…[9] Postcoital bleeding should be considered an indication for prompt referral to a colposcopic clinic and a high risk factor for CIN.…”

Postcoital bleeding: colposcopic and clinicopathologic evaluation

“…S›kl›kla servikovajinal infeksiyon, inflamasyon, travma, servikal polip, ektropion gibi benign lezyonlara ba¤l› geliflirken, servikal intraepitelyal neoplazi (CIN) ve invaziv karsinomlar›n da belirtisi olabilir (2,3) . Postkoital kanamal› hastalarda invazif karsinom ve CIN prevalans› farkl› çal›flmalarda s›ras›yla %3 -17.8 civar›nda rapor edilmifltir (3)(4)(5)(6)(7)(8)(9) .…”