Post Coital Bleeding Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • Post coital bleeding is defined as bleeding that occurs after sexual intercourse

Assessment

History and Examination

History:
  • Frequency of occurrence
  • Related with changes e.g. change in contraceptive pill
  • Associated with pain?
Examination:
  • View cervix
  • Cervical smear if over 25 years old and due under the screening programme
  • Triple swab (high vaginal, endocervical and chlamydia swabs)
  • Any evidence of infection
  • View for polyps

Differential Diagnoses

  • Menstrual irregularity
  • Infection
  • Intermenstrual bleeding
  • Cervical polyps
  • Endometrial polyps
  • Cervical cancer (incidence 1 – 2% of people with post coital bleeding)

Red Flags

If the cervix appears/feels abnormal/suspicious upon speculum examination, refer urgently for colposcopy (2 week wait)

Cervical cancers are rare in women of reproductive age.

  • Risk factors for cervical cancers include:
    • Human Papilloma Virus (HPV)
    • Previous abnormal smear result
    • Multiple sexual partners
    • Smoking

Management

Visually normal cervix/vagina
  • Normal smear result or under 25 years old
    • check swab results and treat as appropriate
    • if all examination and investigation findings are normal, then patient can be reassured.
    • if however symptoms are particularly troublesome consider routine referral to Gynaecology
  • Abnormal smear result
    • if Dyskaryotic smear - direct referral initiated by pathology
    • refer to Colposcopy
Ectropion or polyp with normal smear or under 25
  • Cervical polyps may be removed in primary care
  • Ectropion is a physiological phenomenon and does not require referral unless patient suffers from persistent or annoying symptoms, consider routine referral to Gynaecology
Visually abnormal cervix/vagina
  • Refer to Gynaecology via 2WW

Referral

Referral Criteria

Consider referral to routine gynaecology

  • If troublesome symptoms persist after management in primary care

Refer to Colposcopy under 2ww

  • If vagina or cervix appears/feels abnormal/suspicious

Referral Instructions

  • e-consultation is available for this specialty
  • Referrals should be made via ICG to TRISH (if training has been undertaken) - See user guides (EMIS & S1) for further information.
  • For those Practices who have not received ICG training referrals should be made via eRS
  • Please identify speciality and clinic type

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient Information/Public Health/Self Care

Assurance & Governance

  • This guidance was developed on: 03.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 03.2017
  • Publication Date: 05.2017
  • Review Date: 02.2019
  • Ref No: OG3 - 03.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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