Persistent intermenstrual or postcoital bleeding ⚠️ 🩸
🧠 Clinical mechanism: Bleeding between periods or after sex has cervical, endometrial, infectious and hormonal causes, occasionally malignancy.
🔎 Recognise
- Persistent spotting, contact bleeding, abnormal discharge or pain; assess pregnancy possibility, age, contraception and cervical-screening history.
🛟 First assessment and action
- Examine with informed consent and chaperone, perform pregnancy test when relevant and arrange STI testing/cervical or gynaecological assessment.
🧪 Investigations and reassessment
- Cervical visualisation and further ultrasound/hysteroscopy or referral depend on findings and risk factors.
⚠️ Pitfall / escalation
- Cervical screening is not a diagnostic substitute when a cervix appears cancerous; NICE NG12 supports suspected cancer referral for suspicious cervical appearance.
UK reference: Primary NHS/NICE/RCOG/GMC source.
Editorial draft, 7 November 2026: targeted source-supported educational summary, NOT independent consultant/pharmacist verification or a treatment protocol. Follow up-to-date BNF, NICE and local NHS pathways.
Related: Cervical screening (HPV) · Cervical cancer · Menstrual problems