Clinicopathological evaluation of women with postcoital bleeding

Aim-To determine the percentage of postcoital bleeding and study the correlation between demographic data, clinical findings, cytology, colposcopy and histopathological reports among women with postcoital bleeding.
Materials and Methods: Women ≥18 years of age with postcoital bleeding attending the gynaecology OPD were included in the study. After proper consent, physical and gynaecological examinations were done in 100 patients with postcoital bleeding. Liquid-based cytology was taken from all patients, and colposcopy and cervical biopsy were done when indicated.
The percentage of women with postcoital bleeding in this study was 0.115%. The study identified various causes of postcoital bleeding among women, in which 28 cases were linked to inflammation, 17 cases to infections, and 5 cases had unknown causes (idiopathic). Additionally, 25 cases are non-cancerous (benign), 5 cases show early signs of potential cancer (premalignant), and 20 cases involve confirmed cancerous cells, highlighting the diverse reasons behind postcoital bleeding. The study establishes a significant correlation (p = 0.02) between pap smear results and cervical biopsy outcomes in 100 women with postcoital bleeding. A significant correlation (p = 0.002) was observed between colposcopy grading and cervical biopsy results. This study establishes the correlation between cervical biopsy results with final diagnoses, 45 women underwent biopsy, revealing a range of pathologies. Among cases diagnosed with inflammation, chronic inflammation, and focal dysplasia were noted. Benign diagnoses predominantly consisted of polyps, while premalignant cases included one carcinoma in situ. All 19 malignant cases were confirmed as invasive cancer on histopathological examination (HPE), underscoring cervical biopsy's significance as the gold standard for confirming malignancy, supported by a significant p-value of 0.00 at the 95% Confidence Interval.
Conclusion- All women experiencing post-coital bleeding should undergo a comprehensive assessment, including pelvic examination followed by a pap smear, colposcopy, and biopsy if necessary. If a cervical smear appears normal in women with post-coital bleeding, it does not necessarily exclude the presence of cervical intraepithelial neoplasia or invasive cancer.  Post-coital bleeding should be considered a potentially alarming sign of increased risk for invasive cervical cancer and cervical intraepithelial neoplasia. Timely workup and intervention are recommended.