Unusual Menstrual Bleeding and Intercourse-Related Discharge Concerns

Abnormal menstrual bleeding and occasional blood or brown discharge during intercourse?

Married and trying to conceive since July of this year, hoping to become pregnant with my first child.
Earlier this year, I had a Pap smear that returned normal results.
My menstrual cycle has always been regular, and aside from occasional lower back pain during my period, I have never experienced any discomfort.
Occasionally, during intercourse, I notice a brownish, sticky discharge (which also happens occasionally in daily life), and there has been very minimal bleeding, but neither partner experiences any pain or discomfort; this has been the case even when using contraception, and it has persisted for about a year.

From November 1 to 8, the situation during intercourse remained the same, and I used panty liners almost daily (except for the 9th to 12th) due to slight bleeding.
Notably, when straining during urination, I experienced one or two clots resembling menstrual blood being expelled.
Starting from the 13th, I began to notice more blood being expelled even without straining in the abdomen, leading me to intermittently use sanitary pads.
The situation from the 9th to the 12th was absent, but it reappeared from the 13th to the 18th, followed by my period from the 19th to the 22nd, and then the situation reoccurred from the 23rd to the 30th.

On December 1-2 and 5-6, the previous symptoms were absent, but they reappeared on the 3rd and 4th.
Since December 7, I have experienced continuous bleeding for five days, with menstrual blood being expelled when straining during urination (approximately 10%-20% of a typical menstrual flow).
My period is expected to arrive on the 23rd of this month.
I am concerned about the frequent bleeding and the situation during intercourse that has been occurring since November.
Could you please advise on the possible causes or explanations for this? Thank you!

Amy, 30~39 year old female. Ask Date: 2015/12/11

Dr. Lin Wenbin reply Obstetrics and Gynecology

A physician needs to examine the condition of the cervix and perform an ultrasound to assess the abdominal condition.
Hormonal status should be evaluated if necessary.

Reply Date: 2015/12/11

More Info

Unusual menstrual bleeding and discharge during intercourse can be concerning, especially when they deviate from your normal patterns. Based on your description, there are several potential causes for your symptoms, and it is essential to consider both gynecological and urological factors.

Firstly, the presence of brownish discharge during intercourse, along with occasional light bleeding, may indicate several conditions. One common cause is cervical ectropion, where the cells from the inside of the cervical canal grow on the outside of the cervix. This condition can lead to increased sensitivity and bleeding during sexual activity, particularly if there is friction or pressure. Another possibility is the presence of polyps or fibroids in the uterus, which can also cause irregular bleeding and discharge.

The fact that you have experienced a change in your menstrual cycle, with bleeding occurring outside of your expected period, raises the possibility of hormonal imbalances. Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can lead to irregular menstrual cycles and abnormal bleeding patterns. It is also worth noting that stress and significant lifestyle changes can impact your menstrual cycle.

The discharge you mentioned, particularly the thick, brownish fluid, could be old blood that is being expelled from the uterus. This can happen if there is a delay in the shedding of the uterine lining, which may occur due to hormonal fluctuations. However, the presence of blood clots or a significant amount of blood during urination is concerning and should not be overlooked.

Given that you have had a normal Pap smear earlier this year, it is less likely that cervical cancer is the cause of your symptoms, but it does not completely rule it out. Continuous or unusual bleeding warrants further investigation, especially if it persists or worsens. It is crucial to consult with a healthcare provider who can perform a thorough examination, including a pelvic exam, ultrasound, or additional tests as needed to determine the underlying cause of your symptoms.

In summary, your symptoms could be attributed to several factors, including cervical ectropion, polyps, hormonal imbalances, or even infections. It is essential to seek medical advice to rule out any serious conditions and to receive appropriate treatment. Keeping a detailed record of your symptoms, including the timing and nature of the bleeding and discharge, can be helpful for your healthcare provider in diagnosing the issue. Remember, your health is paramount, and addressing these concerns early can lead to better outcomes.

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