A 35 year old female, with post coital bleeding, next step :
Ans. is a i.e. Clinical examination and pap smear Well friends first I want you to read what Williams has to say on Postcoital bleeding. "Bleeding following intercourse most commonly develops in women aged 20 to 40 years and in those who are multiparous. No underlying pathology is identified in up to two thirds. If an identifiable lesions is found, however, it typically is benign. In a review of 248 women with postcoital bleeding. Selo-Ojeme and co-workers (2004) found that a fouh of cases were caused by cervical eversion. Other causes included endocervical polyps, cervicitis, and less commonly, endometrial polyps. In the cases of cervicitis. Chlamydia trachomatis is a frequent cause. In some women, postcoital bleeding may be from cervical or other genital tract neoplasia. The epithelium associated with cervical intraepithelial neoplasia (CIN) and invasive cancer is thin and friable and readily detaches from the cervix. In women with postcoital bleeding. CIN was found in to 10 percent, invasive cancer in about 5 percent, and vaginal or endometrial cancer in <1 percent. In another study, Jha and Sabharwal (2002) repoed that a number of women with postcoital bleeding had pathologic lesions identified at colposcopic evaluation that had been missed by Pap smear screening. Thus, most women with unexplained postcoital bleeding should undergo colposcopic examination if no other obvious souce of bleeding is identified." So after reading the above text it is clear that - Colposocopy is the most definitive procedure for diagnosis of postcoital bleeding. But here question is specifically saying - a 35 years old female is coming with postcoital bleeding, what is the next step - so obviously in this age group we will first examine the patient, rule out other causes, perform a pap's and still if no diagnosis is made we will go for colposocpy to rule out CIN and Ca cervix.
Clinical examination and pap smear
Visual inspection with acetowhite
Visual inspection with lugol's iodine
Colposcopy directed biopsy