Young female, multigravida presenting with post coital bleeding, vagina - normal, cervix - hyperophied, Next step?
Post coital bleeding is the - most common presentation of CA cervix PAP smear is done when a patient is asymptomatic or sexually active women Here, The patient is symptomatic hence a confirmatory test is warranted to make a diagnosis. Doing a four Quadrant biopsy may help, but it is more of a 'Hit and trial' kind of method since invasion could be staing in a different place away from the 4 biopsies sites. Performing a Colposcopic is the best procedure here than a Pap smear or the 4 Quad biopsy. If diagnosis is not confirmed even with a Colposcopic biopsy then the next step here is Conization of cervix .
Pap smear
Colposcopy biopsy
Cryotherapy
P/Vaginal examination
Cervical Carcinoma