The Prevalence of Pre-invasive and Invasive Lesions of the Cervix in Women with Post Coital Bleeding Referred to Gynecology Oncology Clinic of Afzalipoor Hospital, Kerman from March2015 to March2016

Document Type: Original Article

Authors

1 Assistant Professor of Gynecology Oncology, Afzalipoor School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

2 Associate Professor of Obstetrics & Gynecology, Afzalipoor School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

3 Gynecologist

Abstract

Background: Bleeding during or immediately after the intercourse can be seen in women with benign cervical changes such as polyps, ectropion or infection of the cervix. But, sometimes, important diseases such as cancer of the cervix can be associated with post coital bleeding (PCB). The aim of this study was to find the prevalence of microscopic pre-cancerous lesions of the cervix in women with PCB.
Methods: In this study, 120 women with PCB were entered and studied by liquid based Pap smear, colposcopy and biopsy. Also, some of them were studied with endocervical brush and the obtained data were analyzed through SPSS software.
Results: In this study, 113 of 120 women had normal Pap smear, while 7 ones had abnormal Pap smear and ASCUS was reported in these 7 Pap smear samples. Of 120 studied women, 9 patients (7.5%) had endocervical polyps, 72 patients (60%) had chronic cervicitis, 12 cases (10%) had CIN І, 4 patients (3.3%) had CIN II-III and 2 patients (1.7%) had cervical cancer. Of 18 subjects who had abnormal pathology, 14 patients (77.8%) had normal Pap smear.
Conclusion: Since significant percentage of patients with abnormal pathology had normal Pap smears, it is recommended that all women who complain from persistent and untreatable PCB undergo colposcopy and biopsy. Pap smear alone is not enough for triage these patients due to its vast false-negative reports.

Keywords


  1. Tehranian A, Rezaii N, Mohit M, Eslami B, Arab M, Asgari Z. Evaluation of women presenting with postcoital bleeding by cytology and colposcopy. Int J Gynaecol Obstet 2009; 105(1):18-20.
  2. Selo-Ojeme DO, Dayoub N, Patel A, Metha M. A clinico-pathological study of postcoital bleeding. Arch Gynecol Obstet 2004; 270(1): 34-36.
  3. Abu J, Davies Q, Ireland D. Should women with postcoital bleeding be referred for colposcopy? J ObstetGynaecol 2006; 26(1):45-47.
  4. Lindner LE, Geerling S, Nettum JA, Miller SL, Altman KH. Clinical characteristics of women with chlamydial cervicitis. J Reprod Med 1988; 33(8): 684-90.
  5. Shapley M, Jordan K, Croft PR. An epidemiological survey of symptoms of menstrual loss in the community. Br J Gen Pract 2004; 54(502): 359-63.
  6. Bax CJ, Oostvogel PM, Mutsaers JA, Brand R, Craandijk M, Trimbos JB, et al. Clinical characteristics of Chlamydia trachomatis infections in a general outpatient department of obstetrics and gynaecology in the Netherlands. Sex Transm Infect 2002; 78(6): E6.
  7. Shapley M, Jordan J, Croft PR. A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract 2006; 56(527): 453-60.
  8. Pretorius R, Semrad N, Watring W, Fotheringham N. Presentation of cervical cancer. Gynecol Oncol 1991; 42(1): 48-53.
  9. Khan Z, Appleton F, Turner J. Is cervical intra-epithelial neoplasia symptomatic? J Obstet Gynaecol 2008; 28(3): 336-7.
  10. Viikki M, Pukkala E, Hakama M. Bleeding symptoms and subsequent risk of gynecological and other cancers. Acta Obstet Gynecol Scand 1998; 77(5): 564-9.
  11. Rosenthal AN, Panoskaltsis T, Smith T, Soutter WP. The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding. BJOG 2001; 108(1): 103-6.
  12. Sahu B, Latheef R, AboelMagd S. Prevalence of pathology in women attending colposcopy for postcoital bleeding with negative cytology. Arch Gynecol Obstet 2007; 276(5):471-3
  13. Shapley M, Blagojevic-Bucknall M, Jordan KP, Croft PR. The epidemiology of self-reported intermenstrual and postcoital bleeding in the perimenopausal years.BJOG2013; 120(11): 1348-55.
  14. Ashrafgangoei T, Honarvar Z, Yaseri M, Arab M. Frequency of Significant Cervical Pathology in Women Attending a Teaching Gynaecological Service for Postcoital Bleeding with Normal Cytology. Women’s Health & Gynecology2016; 2(1):1-16.
  15. Jha S, Sabharwal S. Outcome of colposcopy in women presenting with postcoital bleeding and negative or no cytology – results of a 1-year audit. J Obstet Gynaecol2002;22(3): 299-301.