Differential Diagnosis for Bleeding after Intercourse in a 34-year-old
Single Most Likely Diagnosis
- Cervicitis: This is often the most common cause of post-coital bleeding, especially in younger women. Cervicitis can be caused by infections such as chlamydia or gonorrhea, and it leads to inflammation of the cervix, which can cause bleeding after intercourse.
Other Likely Diagnoses
- Cervical Ectropion: A condition where the glandular cells lining the inside of the cervical canal are everted to the outside of the cervix, which can cause bleeding, especially after intercourse.
- Cervical Polyps: These are growths on the cervical canal that can cause bleeding after intercourse due to irritation or trauma during sex.
- Vaginal Dryness or Atrophy: Especially in women who are breastfeeding, postpartum, or in perimenopause, vaginal dryness can lead to bleeding after intercourse due to the lack of lubrication and the fragility of the vaginal tissues.
Do Not Miss Diagnoses
- Cervical Cancer: Although less common, cervical cancer is a critical diagnosis not to miss. Post-coital bleeding can be an early symptom, especially in women who have not had regular Pap smears.
- Endometrial Cancer: Though more common in older women, endometrial cancer can present with postmenopausal or irregular bleeding, including bleeding after intercourse, and should not be overlooked.
- Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause bleeding, among other symptoms, and requires prompt treatment to prevent long-term complications.
Rare Diagnoses
- Vaginal Cancer: A rare type of cancer that can cause bleeding, including after intercourse.
- Uterine Sarcoma: A rare type of cancer that originates in the muscle and supporting tissues of the uterine walls, which can cause abnormal bleeding.
- Blood Clotting Disorders: Conditions such as von Willebrand disease can lead to easy bruising and bleeding, including after intercourse, though these are less directly related to the act of intercourse itself.
Each of these diagnoses has different implications for treatment and management, emphasizing the importance of a thorough evaluation to determine the underlying cause of post-coital bleeding.