Intermenstrual and postcoital bleeding

Unexpected vaginal bleeding, whilst responsible for much anxiety amongst women, is rarely associated with any serious underlying pathology. Nevertheless, bleeding which occurs spontaneously in between menses or after intercourse is recognised as a ‘red flag’ symptom for gynaecological cancer. Infection, hormonal fluctuations, benign cervical and endometrial conditions are, however, more common causes of abnormal bleeding. The role of the generalist clinician is to diagnose and treat uncomplicated conditions, whilst also determining the likelihood of malignancy and referring for further investigations appropriately.