From the Research
For a 32-year-old female with post-coital vaginal bleeding without external trauma, the management should begin with a thorough gynecological examination including a speculum exam to visualize the vaginal canal and cervix, as post-coital bleeding can be a symptom of underlying cervical or vaginal pathology, including cervical cancer, as noted in a study published in 2019 1.
The patient should be referred to a gynecologist for evaluation, which will likely include:
- A Pap smear to screen for cervical cancer and precancerous lesions
- STI testing, including gonorrhea, chlamydia, and trichomoniasis, as these infections can cause post-coital bleeding
- Possibly colposcopy if cervical abnormalities are noted, to further evaluate the cervix for any lesions or abnormalities
Transvaginal ultrasound may be ordered to evaluate for structural causes such as polyps or fibroids, which can also cause post-coital bleeding. If cervical ectropion, a benign condition where columnar epithelium extends onto the vaginal portion of the cervix, is identified as the cause, treatment options include observation, silver nitrate application, or cryotherapy depending on symptom severity. If infection is detected, appropriate antimicrobial therapy should be prescribed, such as ceftriaxone 250mg IM once plus azithromycin 1g orally once for gonorrhea and chlamydia, or metronidazole 500mg orally twice daily for 7 days for bacterial vaginosis or trichomoniasis, as supported by a study published in 2016 2.
The patient should abstain from sexual intercourse until bleeding resolves and treatment is completed, to prevent further irritation or infection. Post-coital bleeding often indicates cervical or vaginal pathology, which could range from benign conditions to more serious concerns like cervical dysplasia or cancer, making prompt evaluation essential for proper diagnosis and treatment, as highlighted in a study published in 2021 3.
It's also important to note that while tranexamic acid has been studied for preventing postpartum hemorrhage, its use in the context of post-coital bleeding is not well established, and more research is needed to determine its efficacy and safety in this setting, as noted in a 2025 study 4.
Overall, the management of post-coital vaginal bleeding should prioritize a thorough evaluation to rule out underlying pathology, and treatment should be tailored to the underlying cause, with the goal of resolving symptoms and preventing future episodes.