The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding

Objectives To document the frequency of pathology in women who complain of postcoital bleeding. To determine whether negative cervical cytology exclud es serious pathology in women with postcoital bleeding. To determine whethe r postcoital bleeding increases the risk of serious pathology in women with an abnormal smear. Design A retrospective study. Setting A university teaching hospital. Population 314 women with postcoital bleeding seen in the gynaecology servi ce from first January 1988 to 31 December 1994, Methods women were identified from the computerised records of the colposco py sen;ice and copies of correspondence, which was routinely retained on co mputer. The latter was searched for the text strings coital and intercourse . Main outcome measure Histopathological diagnosis. Results Twelve women (4%) had invasive cancer: 10 were cervical or vaginal cancers and two endometrial cancers. Eight of the 10 cervical or vaginal ca ncers were clinically apparent, Four women of these 10 had had a normal sme ar before being referred for further investigation of postcoital bleeding. Two of these cancers were visible only with the aid of the colposcope. Thus , 0.6% of women attending a gynaecology service with postcoital bleeding, a normal looking cervix and a normal smear had invasive cancer of the cervix . Cervical intraepithelial neoplasia were found in 54 women (17.%) and 15 w omen (5%) had cervical polyps. Nineteen of the 63 women (30%) with signific ant pathology had a normal or inflammatory cervical smear. No explanation f or the postcoital bleeding was found in 155 women (49%). Conclusions Although invasive cancer is rare in women with postcoital bleed ing, it is much commoner than in the general population. It seems likely th at cervical intraepithelial neoplasia is also associated with postcoital bl eeding, perhaps because the fragile cervical epithelium becomes detached du ring intercourse. Postcoital bleeding should continue to be regarded as an indication of high risk for invasive cervical cancer and for cervical intra epithelial neoplasia. Prompt referral to a colposcopy clinic is indicated, but most women with postcoital bleeding will have no serious abnormality.