Abnormal Vaginal Bleeding: Causes and When to Seek Help - Family Medicine

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Abnormal vaginal bleeding can be a concerning issue for many women, and understanding its causes is crucial for determining when to seek medical help. Based on your description, it seems you have experienced a variety of symptoms, including post-coital bleeding, changes in vaginal discharge, and the presence of blood after using a medication that was expired. Let’s break down these symptoms and their potential implications.

Firstly, post-coital bleeding, which is bleeding that occurs after sexual intercourse, can be caused by several factors. Common causes include cervical irritation, vaginal dryness, or infections such as cervicitis or vaginitis. Given that you experienced pain and swelling after intercourse, it’s possible that there was some trauma to the vaginal or cervical tissues, especially if there was insufficient lubrication. This could lead to minor bleeding, which is typically not a cause for alarm unless it persists or is accompanied by other concerning symptoms.

The presence of yellow-green discharge with a "cottage cheese" appearance suggests a possible yeast infection or bacterial vaginosis. These conditions can cause irritation and inflammation, leading to discomfort and abnormal discharge. Clotrimazole, which you used, is an antifungal medication commonly prescribed for yeast infections. However, using expired medications may reduce their effectiveness, which could explain why your symptoms persisted or worsened.

The appearance of pinkish blood after urination, which later turned to bright red, raises some concerns. This could indicate several possibilities, including:
1. Hormonal Imbalance: If your menstrual cycle is typically around 40 days, the bleeding could be related to hormonal fluctuations. Sometimes, hormonal changes can lead to breakthrough bleeding, especially if you have recently started or stopped medications.

2. Infection: If there is an underlying infection, such as a urinary tract infection (UTI) or a sexually transmitted infection (STI), this could also cause bleeding. The presence of blood in urine can sometimes indicate a UTI, which may require treatment.

3. Cervical or Vaginal Injury: As mentioned earlier, if there was trauma during intercourse, this could lead to bleeding. If the bleeding is minor and resolves quickly, it may not be a cause for concern. However, if it continues or worsens, further evaluation is necessary.

4. Other Conditions: Conditions such as polyps, fibroids, or even more serious issues like cervical dysplasia or cancer can cause abnormal bleeding. Although these are less common, they should not be ruled out, especially if you have persistent symptoms.

Given the complexity of your symptoms and the fact that you have been experiencing changes in your menstrual cycle and discharge, it is advisable to seek medical attention. A healthcare provider can perform a thorough examination, including a pelvic exam, and may recommend tests such as a Pap smear, ultrasound, or STI screening to determine the underlying cause of your symptoms.

In summary, while some causes of abnormal vaginal bleeding may be benign, it is essential to consult with a healthcare professional to rule out any serious conditions and to receive appropriate treatment. Your health and well-being are paramount, and addressing these symptoms early can lead to better outcomes.