Differential Diagnosis for Post-Coital Bleeding

Single Most Likely Diagnosis

• Cervical Ectropion or Cervicitis: This condition is often associated with post-coital bleeding due to the friable nature of the cervical tissue, which can easily bleed after minor trauma such as intercourse.

Other Likely Diagnoses

• Vaginal Dryness or Atrophy: Common in postmenopausal women, vaginal dryness can lead to bleeding after intercourse due to the lack of lubrication and the fragility of the vaginal walls.
• Cervical Polyps: These are growths on the cervical canal that can cause bleeding, especially after intercourse.
• Endometrial Hyperplasia or Polyps: Although less common, these conditions can cause irregular bleeding, including post-coital bleeding, especially if there is associated cervical or vaginal trauma.

Do Not Miss Diagnoses

• Cervical Cancer: Although less likely, cervical cancer is a critical diagnosis not to miss. Post-coital bleeding can be an early symptom, and timely diagnosis is crucial for effective treatment.
• Endometrial Cancer: Similar to cervical cancer, endometrial cancer can present with postmenopausal bleeding or irregular bleeding patterns, including post-coital bleeding, and is critical to diagnose early.

Rare Diagnoses

• Vaginal Cancer: A rare type of cancer that can cause bleeding, including after intercourse.
• Uterine Sarcomas: These are rare tumors of the uterus that can cause irregular bleeding, including post-coital bleeding.
• Foreign Body in the Vagina: Although more common in children, a foreign body in the vagina can cause bleeding and should be considered in the differential diagnosis, especially if other symptoms like discharge or odor are present.

Each of these diagnoses has a different set of risk factors, symptoms, and diagnostic approaches. A thorough medical history, physical examination, and appropriate diagnostic tests (such as Pap smear, colposcopy, biopsy, or imaging studies) are essential for determining the underlying cause of post-coital bleeding.