Differential Diagnosis for Bleeding between Periods after Sex

• Single most likely diagnosis
  • Cervicitis: This condition, which is an inflammation of the cervix, can cause bleeding after sexual intercourse due to the mechanical irritation of the cervix. It is often caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhea.
• Other Likely diagnoses
  • Vaginal dryness or atrophy: Insufficient lubrication during sex can lead to vaginal tears or irritation, resulting in bleeding. This is common in postmenopausal women or those with hormonal imbalances.
  • Endometrial polyps: These are growths in the lining of the uterus that can cause irregular bleeding, including bleeding after sex.
  • Uterine fibroids: Although more commonly associated with heavy menstrual bleeding, fibroids can also cause irregular bleeding, including post-coital bleeding.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Cervical cancer: Although less common, cervical cancer can present with post-coital bleeding. It is crucial to not miss this diagnosis as early detection significantly improves prognosis.
  • Endometrial cancer: Similar to cervical cancer, endometrial cancer can cause irregular vaginal bleeding, including bleeding after sex. It is more common in postmenopausal women but can occur in any woman.
• Rare diagnoses
  • Vaginal cancer: A rare type of cancer that can cause bleeding after sex among other symptoms.
  • Trauma: Physical trauma to the genital area can cause bleeding, which might be noticed after sexual activity.
  • Blood clotting disorders: Although rare, disorders that affect blood clotting can lead to easy bruising and bleeding, potentially noticed after sex.