Abnormal Vaginal Bleeding: Causes and Concerns

Q: Abnormal Vaginal Bleeding: Causes and Concerns

Hello： (1) Based on what you described, the likelihood of ovulatory bleeding is quite high. <br>Other causes of abnormal vaginal bleeding, such as cervical polyps, endometrial polyps, endometrial hyperplasia, and cervical pre-cancerous lesions, can be evaluated through a pelvic e

Vaginal discharge with bleeding symptoms?

In recent years, I have experienced symptoms of abnormal vaginal bleeding with discharge.
After researching online, I found similarities between ovulation bleeding and cervical cancer symptoms, as both can present with abnormal vaginal bleeding.
About five years ago, I had a finger penetration experience, and at that time, my hymen was already broken.
Since then, I have been experiencing discharge with bleeding almost every month.
On August 1st of this year, I went to the hospital for an ultrasound.
The doctor asked if I had engaged in sexual intercourse, and I answered no, thinking that since I hadn't had any finger penetration in over five years, it was accurate to say no.
During the ultrasound, the doctor noted that my ovaries and uterus appeared normal, but the right ovary was obscured by the intestines, so it couldn't be visualized.
The doctor mentioned that if there were any abnormal findings, the intestines would not cover it.
After the examination, the doctor suggested that I could take birth control pills or just monitor the situation.
They also mentioned that if I was concerned, I could have an ultrasound every six months.
However, in the past few months, I have been experiencing 2-3 days of ovulation bleeding along with lower abdominal pain.
My last menstrual period was from November 30 to December 6.
On December 10, I engaged in foreplay with my boyfriend, followed by penetration, but he said there was no complete engorgement, and it felt like only the front part entered the vagina, with his fingers being longer than his genitalia.
On December 13, I noticed clear discharge with bright red streaks of blood, which lasted for only one day, and I felt pain in my left abdomen.
I would like to ask the doctor if this type of sexual activity has already touched the cervix, as I am concerned about other issues.
Are my symptoms indicative of ovulation bleeding? Is it common for women to experience ovulation bleeding every month? I noticed that the app indicates ovulation bleeding symptoms after my menstrual period ends.
Should I undergo further cervical smear testing? Is getting the cervical cancer vaccine still effective for protection?

A-Pang, 20~29 year old female. Ask Date: 2016/12/15

Dr. Yang Wangjun reply Obstetrics and Gynecology

Hello: (1) Based on what you described, the likelihood of ovulatory bleeding is quite high.
Other causes of abnormal vaginal bleeding, such as cervical polyps, endometrial polyps, endometrial hyperplasia, and cervical pre-cancerous lesions, can be evaluated through a pelvic examination, ultrasound, and Pap smear.
Since you have concerns, it is certainly advisable to undergo a Pap smear.
(2) The cervical cancer vaccine is primarily administered to girls who have not engaged in sexual intercourse and have not been infected with human papillomavirus (HPV).
Typically, over 80% of individuals who have had sexual intercourse will become infected with HPV, most of whom will clear the virus naturally, with only a small percentage remaining as carriers.
If one is already a carrier, the cervical cancer vaccine will not be beneficial.
If someone has been infected with HPV but is not currently a carrier, receiving the cervical cancer vaccine is said to potentially enhance the concentration of antibodies in the bloodstream.
Thank you for your message!

Reply Date: 2016/12/15

More Info

Abnormal vaginal bleeding can be a source of significant concern for many women, and understanding its causes is crucial for effective management. Based on your description, it appears that you have been experiencing intermittent abnormal bleeding, particularly around the time of ovulation, which is often referred to as ovulation bleeding. This type of bleeding is generally considered benign and is attributed to hormonal fluctuations that occur during the menstrual cycle.

Ovulation bleeding typically occurs when there is a slight drop in estrogen levels just before ovulation, which can lead to a small amount of bleeding as the endometrial lining sheds slightly. This bleeding can manifest as light spotting, often pink or brown in color, and usually lasts for a short duration, typically one to three days. It is important to note that not all women experience ovulation bleeding, and its occurrence can vary from cycle to cycle.

In your case, you mentioned experiencing this type of bleeding for several years, often accompanied by clear discharge and occasional abdominal pain. The fact that your ultrasound results showed normal ovaries and uterus is reassuring, as it suggests that there are no significant structural abnormalities contributing to your symptoms. However, the presence of abdominal pain alongside the bleeding warrants further investigation, as it could indicate other underlying issues, such as ovarian cysts or endometriosis.

Regarding your question about whether the sexual activity you described could have impacted your cervix, it is possible but unlikely that such activity would cause significant trauma to the cervix unless there was vigorous penetration. Generally, light contact or finger insertion does not typically lead to cervical injury. However, if you experience persistent pain or unusual bleeding following sexual activity, it is advisable to consult with a healthcare provider for a thorough evaluation.

As for your concerns about cervical cancer, it is essential to keep in mind that while abnormal bleeding can be a symptom of cervical cancer, it is often accompanied by other signs such as unusual discharge, pelvic pain, or pain during intercourse. Regular Pap smears are crucial for early detection of cervical changes that could lead to cancer. If you have not had a Pap smear recently, it would be prudent to schedule one, especially since you have a history of abnormal bleeding.

Regarding the HPV vaccine, it is effective in preventing certain strains of the human papillomavirus that are associated with cervical cancer. If you have not yet received the vaccine, it is highly recommended, as it can provide significant protection against cervical cancer and other HPV-related diseases.

In summary, while your symptoms may align with ovulation bleeding, the combination of persistent spotting, abdominal pain, and your sexual history suggests that further evaluation is warranted. A Pap smear and possibly additional imaging or tests may be necessary to rule out any other conditions. It is always best to maintain open communication with your healthcare provider about your symptoms and concerns to ensure appropriate care and peace of mind.

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