Postcoital bleeding

Specialty| Gynecology
Symptoms| Vaginal bleeding during or after sexual intercourse[1]
Usual onset| Reproductive age and older[2]
Treatment| Depends on cause[2]
Frequency| Common, 5%-10% of females[2]

Postcoital bleeding (PCB) is vaginal bleeding after sexual intercourse that is not related to menstruation.[1] Though some cause are with associated pain, it is typically painless and frequently associated with intermenstrual bleeding.[2]

Causes include cervical ectropion in around one third of cases, and cervical or endometrial polyps in 5% to 18% of cases.[2] Other common causes include sexually transmitted infection, pregnancy problems and trauma, and in older females, vaginal atrophy.[2] It may be an easly signs of cervical or endometrial cancer.[2] Endometriosis, vulvovaginitis, pelvic inflammatory disease, and malpositioned intrauterine device may also cause PCB.[1][2] Diagnosis involves examination of the vagina and cervix, taking swabs, and sometimes a biopsy.[3] Other tests may include a pregnancy test, 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.[2]

Postcoital bleeding is common, affected around 5% to 10% of females.[1][2]

## Contents

* 1 Causes
* 2 Diagnosis and treatment
* 3 Epidemiology
* 4 In society and culture
* 5 References

## Causes[edit | edit source]

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:

* pelvic inflammatory disease[10]
* pelvic organ prolapse
* uterine disease[11]
* chlamydia or other sexually transmitted infection[10][12][13]
* atrophic vaginitis[10]
* childbirth
* inadequate vaginal lubrication[9]
* benign polyps
* cervical erosion (inflammation of the cervix)[10][9]
* cervical or vaginal cancer[10]
* anatomical abnormality of the uterus, vagina or both.[11]
* pregnancy
* endometrial polyps
* endometrial hyperplasia
* endometrial carcinoma
* leiomyomata
* cervicitis
* cervical dysplasia
* endometriosis
* coagulation defects
* trauma[9]

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[edit | edit source]

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

* a pregnancy test
* a pelvic examination[10]
* obtaining tissue samples
* pap smear
* colposcopic examination of the vagina and cervix
* ultrasound
* histogram
* cultures for bacteria[11]
* biopsy of tissues[9]

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[edit | edit source]

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]

## In society and culture[edit | edit source]

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[edit | edit source]

1. ↑ 1.0 1.1 1.2 1.3 1.4 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}}`: `|access-date=` requires `|url=` (help); `|archive-url=` requires `|url=` (help); 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 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.

Classification|

* ICD-10: N93.0

|

* v
* t
* e

Outline of human sexuality

Physiology and biology|

* Erection
* Insemination
* Intersex
* Libido
* Nocturnal emission
* Orgasm
* Female and male ejaculation
* Pelvic thrust
* Pre-ejaculate
* Pregnancy
* Sexual arousal
* Sexual stimulation

Health and
education|

* Birth control
* Condom
* Masters and Johnson
* Reproductive medicine
* Andrology
* Gynaecology
* Urology
* Safe sex
* Sex education
* Sex therapy
* Sexology
* Sexual dysfunction
* Erectile dysfunction
* Hypersexuality
* Hyposexuality
* Sexual medicine
* Sexual surrogate
* Sexually transmitted infection

Identity and diversity|

* Gender binary
* Gender identity
* Men who have sex with men
* Sexual identity
* Sexual orientation
* Women who have sex with women

Law|

* Age of consent
* Criminal transmission of HIV
* Child sexual abuse
* Incest
* Indecent exposure
* Obscenity
* Sexual abuse
* Cybersex trafficking
* Rape
* Sex trafficking
* Sexual assault
* Sexual harassment
* Sexual misconduct
* Sexual slavery
* Sexual violence

History|

* Blue Movie
* Counterculture of the 1960s
* Feminist sex wars
* Golden Age of Porn
* History of erotic depictions
* Sexual revolution

Relationships
and society|

* Anarchism and love/sex
* Extramarital sex
* Family planning
* Flirting
* Marriage
* Modesty
* Polyamory
* Premarital sex
* Promiscuity
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* Sexual abstinence
* Sexual addiction
* Sexual attraction
* Sexual capital
* Sexual ethics
* Sexual objectification
* Sexual slang

By country|

* Ancient Rome
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* Japan
* Philippines
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Sexual
activities|

* Conventional sex
* Anal sex
* Bareback
* BDSM
* Child sex
* Creampie
* Edging
* Erotic sexual denial
* Fetishism
* Fingering
* Fisting
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* Group sex
* Masturbation
* Mechanics of sex
* Nipple stimulation
* Non-penetrative sex
* Facial
* Foot fetishism
* Footjob
* Forced orgasm
* Frot
* Handjob
* Mammary intercourse
* Sumata
* Oral sex
* 69
* Anilingus
* Cunnilingus
* Fellatio
* Irrumatio
* Paraphilia
* Pompoir
* Quickie
* Sex in space
* Sex positions
* Sexual fantasy
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* Sexual intercourse
* Foreplay
* Sexual penetration
* Swinging
* Tribadism
* Urethral intercourse
* Urolagnia
* Virtual sex
* Cybersex
* Erotic talk
* Wet T-shirt contest

Sex industry|

* Red-light district
* Adult video games
* Erotica
* Pornography
* Film actor
* Prostitution
* Survival sex
* Sex museum
* Sex shop
* Sex tourism
* Child
* Female
* Sex worker
* Sex toy
* doll
* Strip club
* Webcam model

Religion and
sexuality|

* Buddhism
* Christian demonology
* Daoism
* Islam
* Mormonism
* Sex magic

* v
* t
* e

Female reproductive system

Internal|

| Adnexa|

| Ovaries|

| Follicles|

* corpus
* hemorrhagicum
* luteum
* albicans
* Theca of follicle
* externa
* interna
* Follicular antrum
* Follicular fluid
* Corona radiata
* Zona pellucida
* Membrana granulosa
* Perivitelline space

|

Other|

* Germinal epithelium
* Tunica albuginea
* cortex
* Cumulus oophorus
* Stroma
* Medulla

Fallopian tubes|

* Isthmus
* Ampulla
* Infundibulum
* Fimbria
* Ostium

Ligaments|

* Ovarian ligament
* Suspensory ligament

Wolffian vestiges|

* Gartner's duct
* Epoophoron
* Vesicular appendages of epoophoron
* Paroophoron

Uterus|

| Regions|

* Body
* Uterine cavity
* Fundus
* Cervix
* Cervical canal
* Supravaginal portion
* Uterine horns

|

Layers|

* Endometrium
* epithelium
* Myometrium
* Perimetrium
* Parametrium

Ligaments|

* Round ligament
* Broad ligament
* Cardinal ligament
* Uterosacral ligament
* Pubocervical ligament

General|

* Uterine glands
* Urogenital diaphragm

Vagina|

* Fossa of vestibule of vagina
* Vaginal fornix
* Hymen
* Vaginal rugae
* Support structures
* Vaginal epithelium

External|

| Vulva|

| Labia|

* Mons pubis
* Labia majora
* Labia minora
* Frenulum of labia minora
* Vulval vestibule
* Vaginal orifice
* Vestibular glands
* Bartholin's glands
* Skene's glands

|

Clitoris|

* Crus
* Body
* Frenulum
* Corpus cavernosum
* Bulb of vestibule
* Glans
* Clitoral hood

Urethra|

* Urethral crest
* External urethral orifice

Blood supply|

* Arteries
* Ovarian artery
* Uterine artery
* Arcuate artery
* Vaginal artery
* Spiral artery
* Veins
* Ovarian vein
* Uterine vein
* Uterine venous plexus
* Vaginal venous plexus

Other|

* G-spot
* Urethral sponge
* Perineal sponge

* v
* t
* e

Female genital surgical and other procedures (gynecological surgery) (ICD-9-CM V3 65–71, ICD-10-PCS 0U)

Adnexa|

| Ovaries|

* Oophorectomy
* Salpingoophorectomy

|

Fallopian tubes|

* Falloposcopy
* Salpingectomy
* Tubal ligation
* Essure
* Tubal reversal

Uterus|

| General:|

* Genitoplasty
* Hysterectomy
* Hysterotomy
* Pelvic exenteration
* Uterine artery embolization
* Transplantation

|

Uterine cavity:|

* Hysteroscopy
* Vacuum aspiration

Endometrium:|

* Endometrial biopsy
* Endometrial ablation

Myometrium:|

* Uterine myomectomy

Cervix:|

* Colposcopy
* Cervical conization
* LEEP
* Cervical cerclage
* Cervical screening (pap test)
* Cervicectomy
* Pessary insertion

Vagina|

* Vaginectomy
* Culdoscopy
* Culdocentesis
* Episiotomy
* husband stitch
* Hymenotomy
* Colpocleisis
* Hymenorrhaphy
* Vaginal wet mount
* Vaginal transplantation

Vulva|

* Vulvectomy
* Female genital mutilation
* Labiaplasty
* Clitoral hood reduction
* Vestibulectomy

Medical imaging|

* Gynecologic ultrasonography
* Hysterosalpingography

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