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Post coital bleeding – Information for GPs

Definition

Non-menstrual bleeding that occurs after sexual intercourse

Red flag symptoms

  • Postmenopausal bleeding (PMB) i.e. bleeding >12 months after last period
  • Suspicious cervix on examination – refer to colposcopy 2WW

Referral criteria (when to refer)

  • Persistent PCB with no obvious cause – USS and referral if any abnormal finding
  • Consider referral for PCB for over 6 months or if bleeding particularly heavy

Management

  • Routine examination and swabs (remember Chlamydia)
  • Perform smear (ONLY if due)
  • If an ectropian is found – consider change in contraception. Ectropia are commonly hormone induced
  • Note – ROUTINE CRYOTHERAPY for ectropian is not performed as high risk of recurrence and risk of scarring
  • If cervical polyp found – please see RSS guidance

Investigations prior to referral

  • Chlamydia screening
  • High vaginal swab
  • Pelvic USS
  • NB: DON’T perform a cervical smear if outside the screening programme

Information to include in referral letter

  • Describe problem (cycle, quantity e.g. pad usage, duration) and effect on quality of life
  • FBC and USS results
  • Current contraception
  • Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the appointment
  • Treatment options please include which tried and whether effective

Desirable information

  • Indication of parity
  • Expectations of referral
  • Exclusions of pathology and reassurance
  • Endometrial Ablation/TCRE
  • Hysterectomy
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