From the Guidelines
Patients experiencing bleeding after intercourse should promptly consult a healthcare provider for evaluation, as this symptom can indicate various conditions ranging from minor issues to more serious concerns. The approach to any patient with postcoital bleeding begins with a detailed history and physical examination to determine the origin of bleeding, as postcoital hemorrhage from the patient’s sexual partner may sometimes be mistaken for the patient's own bleeding 1. During the medical visit, the provider will likely perform a pelvic examination to check for cervical inflammation, polyps, or lesions, and may conduct tests including Pap smears, STI screening, and possibly colposcopy or biopsy if needed. Some common causes of postcoital bleeding include cervical inflammation, infections, hormonal changes, cervical polyps, or rarely, cervical cancer. Treatment depends on the underlying cause - infections may require antibiotics; hormonal issues might be addressed with low-dose birth control pills; and cervical polyps typically require removal in-office. In the interim, patients should abstain from sexual activity until evaluated, use pads (not tampons) to monitor bleeding, and note any associated symptoms like pain or unusual discharge. Patients should follow up as recommended and return immediately if bleeding becomes heavy or is accompanied by severe pain or fever, as these may indicate complications requiring urgent attention. It is also important to consider other potential causes of postcoital symptoms, such as coital angina, which is angina that occurs immediately after sexual activity, although this is more relevant to cardiovascular disease 1. However, the initial step in managing postcoital bleeding should focus on gynecological evaluation rather than cardiovascular concerns, unless the patient has a known history of heart disease. Given the potential for serious underlying conditions, prompt medical evaluation is crucial for patients experiencing bleeding after intercourse.
From the Research
Postcoital Bleeding Evaluation
- Postcoital bleeding refers to spotting or bleeding that occurs after intercourse and is not related to menstruation, with a prevalence ranging from 0.7 to 9.0 percent of menstruating women 2.
- The causes of postcoital bleeding can be benign, such as cervicitis or cervical polyps, but can also be a sign of a more serious condition like cervical cancer 2.
Recommendations for Evaluation
- There are currently no recommendations from governing bodies such as the American College of Obstetricians and Gynecologists on evaluating and treating women with postcoital bleeding 2.
- The American College of Obstetricians and Gynecologists recommends that pelvic examinations be performed when indicated by medical history or symptoms 3.
- The US Preventive Services Task Force found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women 4.
Pelvic Examination Considerations
- Pelvic examinations may be performed at the time of routine Pap tests to aid in technical issues with the Pap test itself, but are not recommended for screening purposes 5.
- The decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician-gynecologist or other gynecologic care provider 3.
- Maximizing comfort should be the goal of the pelvic examination, with considerations for lubrication use, speculum selection and insertion, and patient demographics and history 6.