Women Health : Inter Menstrual and Post coital Bleeding. Inter Menstrual Bleeding (1MB) is a vaginal bleeding during menstrual cycle. Post coital Bleeding (PCB) is non menstrual bleeding that happens right away after sexual intercourse.
The Common Causes
- Small mass developed in the lining of womb or neck of womb (polyp)
• Infection on neck of the womb
• Harmless tumor known fibroid in the womb
• Use of OC pill, a pill to prevent pregnancy
• In 1-2 % it is usually seen in the centre of the cycle when egg is released
• Women with copper T in the womb
• Some medication which amplify bleeding
• Cancer at the neck or mouth of womb.
Patient with underlined complaints need to have a diagnosis is made based on the history regarding her menses and associated complaints, current medication and any medical disorders. A comprehensive examination is necessary including pelvic examination to diagnose causes for the bleeding like polyp and infection. Pap smear sample is also taken by surface scarping of mouth of the womb with a wooden or plastic spatula and sent for microscopy. It is primarily a screening test which aids to identify suspicious changes in the womb neck. Additional tests are essential for verification if the Pap test is irregular. In western countries females undertake this test at regular intervals. In India it is suggested for female above 35 years of age even with no signs and in younger age with underlined symptoms or when there is a doubt on local pelvic examination.
Further investigation may be:
Ultrasound: Transvaginal ultrasound done through the vaginal which is the best for analysing the abnormalities in and around the womb. Like polyp and fibroid.
Hysteroscopy: Hysteroscope is a telescope like instrument which helps for direct visualization of inside womb and biopsy is also possible from suspicious parts. Polyp or fibroid can also be removed with hysteroscopy without any major operations. In several centers, it is made as a clinic procedure.
Colposcopy is made with a tool to enlarge the surface of the womb magnification of 15 40 times & colpomicroscope 100 150 times. It is for female with irregular smears & H/0 contact bleeding regardless of existence of negative smears lesion is not clinically identified colposcopic absorbed biopsy offers maximum dependability.
Management:
Management depending on the cause :
• Hysteroscopic removal for Fibroid and polyp in the womb
• In case of bleeding due to OC pill or copper T – OC pill is stopped or copper T is removed.
• In case of infection of the mouth of the womb – Antibiotics based on orgasm. Trace and treat 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
If coupled with white discharge and trouble, and also persistent symptoms in spite 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
Altius Hospital
No. 6/63, 59th Cross, 4th Block, Rajajinagar,
Entrance (Opp.)to, MEI Polytechnic, Bangalore -10.
Ph : 080 23151873. Mobile : 9844291777 email : endoram2006@yahoo.in
www.laparoscopicsurgeries.com
