Post-Intercourse Bleeding: Causes and Seeking Solutions

Q: Post-Intercourse Bleeding: Causes and Seeking Solutions

Hello： (1) A pelvic examination can reveal the source of the bleeding. <br>(2) Generally, it is difficult to visually assess precancerous lesions of the cervix, and a Pap smear is necessary for diagnosis. <br>Typically, precancerous lesions of the cervix rarely present with bleed

Postcoital bleeding

Hello, I would like to ask a few questions.
First, let me briefly summarize my medical history.
On December 26, I underwent a suction curettage (abortion) and experienced bleeding for 10 days, followed by brown discharge.
After taking medication to promote uterine contractions, I started to have fresh bleeding.
Ten days later, during a follow-up visit, it was found that there were retained blood clots, and a urine test indicated that I was still pregnant.
Therefore, on January 14, I underwent another suction curettage to remove the blood clots.
After that, the bleeding gradually decreased over the next 10 days, and I took some traditional Chinese medicine to replenish my energy and blood.
I then began waiting for my menstrual period to arrive (I had sexual intercourse three weeks after the bleeding stopped), but my period never came.
I consulted several obstetricians and gynecologists but did not take any medication to induce menstruation.
Until the morning of March 5, after sexual intercourse, I experienced some bleeding.
The next morning, when I went to the bathroom, a significant amount of blood flowed out, with the heaviest bleeding occurring in the first three days.
I was unsure if this was my menstrual period, and it lasted for about 11 days.
On April 3, I started to notice brown discharge, which gradually increased but was manageable with a panty liner.
On the evening of April 9 and the morning of April 10, I continued to have brown discharge, but after having sexual intercourse that day, there was brown, watery discharge on the bedsheet.
When I woke up, the brown discharge was gone, replaced by pink spotting.
On April 11, I noticed red blood droplets in the toilet, and afterward, when wiping, sometimes it was pink and sometimes brown.
Today, I visited an obstetrician, and the endometrial thickness was 0.4 cm.
I would like to ask:
1.
Is the bleeding from the uterus, cervix, or vagina, and how can this be determined? Can a pelvic examination provide this information?
2.
Is there a suspicion of cervical cancer? (I had a Pap smear in 2012 that showed inflammation.)
3.
The doctor prescribed me Dailian (a contraceptive) and a hemostatic agent (for 21 days).
Is it safe to take these? Given my current situation, can I take the hemostatic agent first and then have a Pap smear, or should both be taken together?
I apologize for the lengthy message, and I appreciate your patience in responding.
Thank you.

Wendy, 20~29 year old female. Ask Date: 2016/04/11

Dr. Yang Wangjun reply Obstetrics and Gynecology

Hello: (1) A pelvic examination can reveal the source of the bleeding.
(2) Generally, it is difficult to visually assess precancerous lesions of the cervix, and a Pap smear is necessary for diagnosis.
Typically, precancerous lesions of the cervix rarely present with bleeding symptoms.
In contrast, cervical cancer can be visually identified as cauliflower-like lesions on the cervix accompanied by bleeding.
(3) Based on your description, the likelihood of abnormal uterine bleeding due to endometrial issues is higher.
Usually, after a miscarriage, the hormonal secretion of the entire ovulatory axis does not return to normal, leading to abnormal shedding and bleeding of the endometrium.
Treatment often involves regulating the menstrual cycle, which can be achieved with medications like Dydrogesterone.
Pure estrogen can also be used in conjunction with progesterone to regulate the menstrual cycle, and medications to promote uterine contractions and hemostatic agents can be added for symptomatic treatment.
Thank you for your message!

Reply Date: 2016/04/11

More Info

Post-intercourse bleeding can be a concerning issue for many women, especially when it follows a history of reproductive health challenges. Based on your detailed medical history, it seems that you have experienced a series of complications following your abortion, including prolonged bleeding and irregular menstrual cycles. Let's break down your questions and concerns regarding the bleeding you are experiencing.

1. Determining the Source of Bleeding: The first step in understanding whether the bleeding is coming from the uterus, cervix, or vagina is through a thorough examination by a healthcare provider. An internal examination (pelvic exam) can help identify any abnormalities in the cervix or vagina, such as lesions or signs of infection. Additionally, imaging studies like an ultrasound can provide insights into the condition of the uterus and any retained products of conception. If the bleeding is bright red and occurs after intercourse, it may suggest cervical or vaginal irritation, while dark brown or coffee-colored discharge often indicates older blood, potentially from the uterus.

2. Concerns About Cervical Cancer: Given your history of abnormal Pap smears and inflammation, it is prudent to be vigilant about the possibility of cervical cancer. However, the presence of bleeding does not automatically indicate cancer. Other factors, such as hormonal imbalances, infections, or benign conditions like polyps or fibroids, can also cause similar symptoms. Regular Pap smears and HPV testing are essential for monitoring cervical health, especially if you have had previous abnormalities.

3. Medication and Treatment: You mentioned that your doctor prescribed Dailian (a form of hormonal contraception) and a hemostatic agent. Hormonal contraceptives can help regulate your menstrual cycle and may reduce the occurrence of breakthrough bleeding. It is generally safe to start taking the prescribed medications, but it is crucial to follow your doctor's instructions. If you are experiencing significant bleeding, it may be beneficial to take the hemostatic agent as directed while also scheduling a follow-up appointment for a Pap smear. This way, you can address both the bleeding and monitor your cervical health simultaneously.

In addition to these points, it is essential to consider the psychological impact of your medical history. The stress and anxiety associated with recurrent bleeding and previous procedures can exacerbate your symptoms. Engaging in stress-reducing activities, seeking counseling, or joining support groups can be beneficial.

Lastly, if you notice any alarming symptoms such as severe pain, heavy bleeding (soaking through pads in an hour), or fever, seek immediate medical attention. These could be signs of complications that require urgent care.

In summary, while post-intercourse bleeding can be alarming, understanding the potential causes and working closely with your healthcare provider can help you manage your symptoms effectively. Regular follow-ups and open communication with your doctor are key to ensuring your reproductive health remains a priority.

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