Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Rawan A. Obeidat and Samir A. Saidi
Background: Dependent on local policies and availability of expertise it can be normal practice to refer patients will postcoital bleeding (PCB) to the colposcopy clinic despite having a prior negative smear. It is thought that anxiety over concern over the possibility of occult cancer or high grade CIN (CIN2/3) prompts referral. We therefore studied the prevalence of these abnormalities in this patient group and their outcomes.
Methods: A retrospective study of all patients referred to the Leeds colposcopy clinics with PCB during the 69-month period from March 2005 to December 2010. Patients were identified from the colposcopy clinic database. Those with an overtly suspicious-looking cervix were excluded. Subsequent histology and cytology results were obtained from the Leeds Teaching Hospitals pathology results server. Smear results not available through the results server were obtained from the West Yorkshire Cervical Screening Authority where possible.
Results: A total of 1470 patients were referred to our colposcopy clinics during the study period due to PCB. The overall prevalence of CIN was 12.1% (179/1470) and of high grade CIN was 3.8% (56/1470). There were six cases of cervical cancer (0.4%) (6/1470), all of which had abnormal smears (five had severe dyskaryosis and one with suspected invasion). There was one case of CGIN and one case of endometrial cancer identified in the study group.
1074 out of 1470 women had a negative smear within the previous three years of their referral to the colposcopy clinics. Of the women with a negative smear history, one patient had CGIN (0.09%) (1/1074) in a cervical biopsy, but not in the subsequent LLETZ. The prevalence of CIN was 9.0% (97/1074) and of high grade CIN was 2.2% (24/1073). There were no cases of cervical cancer detected.
Conclusion: Postcoital bleeding is a common problem and is reported to be associated with a higher incidence of CIN than in the general population. However, in a woman with a negative smear history and a normal-looking cervix is rarely a sign of significant pathology. It is therefore inappropriate to refer such patients to the colposcopy clinic. Referral to colposcopy should be reserved for selected cases in accordance with NHSCSP guidance. Further study is also needed to standardise the management of post-coital bleeding and indications for referral to the colposcopy clinic.