Inter Menstrual Bleeding (1MB) refers to vaginal bleeding in between periods.
Post coital Bleeding (PCB) is non menstrual bleeding that occurs immediately after sexual intercourse
The Common Causes
- Small mass arising from the lining of womb or neck of womb (polyp)
- Infection of opening or neck of the womb,
- Harmless tumor called fibroid in the womb,
- During OC pill use (pill to prevent pregnancy) when dosage is very less,
- In 1-2 % it is normally seen in the middle of the cycle when egg is released,
- In some women with copper T in the womb,
- Certain medication which increase the bleeding,
- Also in cancer of body, neck or mouth of womb.
When a patient comes with the above complaints a detailed history is taken regarding her menses and associated complaints, also details about current medication, any medical disorders. A detailed examination is done including pelvic examination to look for local causes for the bleeding like polyp and infection which are easily made out during the examination. Also a pap smear is taken which is the surface scarping of mouth of the womb with a wooden or plastic spatula and sent for microscopy. It is mainly a screening test which helps to detect suspicious changes in the neck of the womb. Further tests are necessary for confirmation when the Pap test is abnormal. In western countries women undergo this test periodically. In India it is recommended for women over 35 years of age even without symptoms and in younger age with the above symptoms or when there is a suspicion on local pelvic examination.
Further investigation may be:
Ultrasound: Transvaginal ultrasound which is done through the vaginal which has got a very high resolution and is the best for visualizing the womb any abnormalities in and around the womb. Like polyp and fibroid.
Hysteroscopy: Hysteroscope is a telescope like instrument which allows direct visualization inside the womb and biopsy can be taken from the suspicious area. Also polyp or fibroid can be removed with hysteroscopy without any need for a major surgery. In many centers, it is done as a clinic procedure.
Colposcopy is done with an instrument to magnify the surface of the womb magnification of 15 40 times & colpomicroscope 100 150 times. It is done for women with abnormal smears & H/0 contact bleeding despite presence of negative smears lesion is not clinically detected colposcopic directed biopsy offers maximum reliability.
Management is dependent on the cause of the bleeding:
- Fibroid and polyp in the womb hysteroscopic removal
- In case when the bleeding is with OC pill or due to copper T it will resolve once the OC pill is stopped or copper T is removed.
- In case of infection of the mouth of the womb Antibiotics dependent on orgasm involved. Contact tracing and treatment of sexual partners.
Can be treated conservatively
If associated with white discharge and trouble symptoms persistent inspite of treatment then the lesion can be burnt with electrocautery or with a globe of ice
When gynecological cancer is suspected, further investigation to be done urgently.
This is a new vaccine called GARDASIL, which has been introduced to prevent the development of cancer due to certain types of virus called Human Papilloma Virus (HPV). This is recommended between ages of 13 – 36 yrs. preferably it should be taken before the episode of 1st intercourse.
-Dr B Ramesh
No. 6/63, 59th Cross, 4th Block, Rajajinagar,
Entrance (Opp.)to, MEI Polytechnic, Bangalore -10.
Ph : 080 23151873. Mobile : 9844291777 email : email@example.com