Postcoital bleeding refers to spotting or bleeding unrelated to menstruation that occurs during or after sexual intercourse. It can be a sign of serious underlying pathology and is usually alarming for patients. About one-third of patients also have abnormal uterine bleeding that is not associated with coitus and about 15 percent have dyspareunia [1,2].
This topic will discuss causes of postcoital bleeding, the likelihood that cancer is the cause, and an approach to management. Other causes of abnormal uterine bleeding and evaluation of women with other types of abnormal uterine bleeding can be found separately. (See "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women".)
PREVALENCE AND NATURAL HISTORY
Postcoital bleeding, while uncommon, is not rare in community populations. The point prevalence determined in large community surveys using self-completed questionnaires ranges from 0.7 to 9 percent [3,4]. One study reported an annual cumulative incidence of about 6 percent of menstruating women . Another reported a prevalence of 5 percent among patients being seen in a hospital's obstetrics and gynecology outpatient department . These disparities are due to variations in study design, including differences in symptom definition, time range in which the symptom occurred (past month to six months), frequency (ever versus frequently), age distribution of the population, and prevalence of sexually transmitted infection and use of hormones. In addition, some studies included women not having sexual relations in the study population.
In naturally menstruating women, the two-year cumulative incidence of postcoital bleeding has been reported as 8 percent with high rates of spontaneous resolution (51 percent for two years without recurrence) .
Cancer — The most serious cause of postcoital bleeding is cervical cancer. About 11 percent of women with cervical cancer present with postcoital bleeding (range 0.7 to 39 percent) . The proportion of women with cervical cancer who present with bleeding has fallen over time, probably due to widespread use of screening programs that identify premalignant and malignant cervical disease. It is generally felt that premalignant disease is asymptomatic [9,10]. In addition, adenocarcinoma accounts for an increasing proportion of cervical cancer cases and may be less likely to cause postcoital bleeding than squamous cancer since the lesion may be high in the endocervical canal and protected from trauma during coitus [3,9].