Differential Diagnosis for Post-Coital Bleeding

Single Most Likely Diagnosis

• Cervical ectropion or cervical polyp: These are common benign conditions that can cause post-coital bleeding due to the mechanical trauma of intercourse.

Other Likely Diagnoses

• Cervicitis: Inflammation of the cervix, which can be caused by various factors, including hormonal changes or mild infections, even if the STI panel is negative.
• Vaginal atrophy: Thinning and drying of the vaginal walls, often due to hormonal changes, which can lead to bleeding after intercourse.
• Endometrial polyps: Growths in the lining of the uterus that can cause bleeding, including post-coital bleeding.

Do Not Miss Diagnoses

• Cervical cancer: Although less common, it is crucial to rule out cervical cancer, as it can present with post-coital bleeding. Regular screening and further diagnostic tests (like colposcopy or biopsy) are essential.
• Endometrial cancer: Similar to cervical cancer, endometrial cancer is a critical diagnosis not to miss, as it can also cause post-coital bleeding among other symptoms.

Rare Diagnoses

• Vaginal or cervical varices: Enlarged veins in the vagina or cervix that can rupture and bleed during intercourse.
• Bleeding disorders: Conditions like von Willebrand disease or platelet function disorders that can increase the risk of bleeding, including post-coital bleeding.
• Uterine sarcomas: Rare malignant tumors of the uterus that can cause a variety of symptoms, including abnormal bleeding.