Thursday, December 16, 2010

Are We Uncomfortable Yet?

A 35 year old woman presents to you in clinic with a complaint of vaginal bleeding after sex. This has only started happening recently; she says, "I've had dozens of partners in the past and this is new." The bleeding happens during and right after coitus. She does not have menorrhagia, irregular menstrual cycles, or intermenstrual bleeding in the absence of coitus. There is no pain, dyspareunia, or dysuria. Her partner is asymptomatic. She has not seen any doctors ever, and is worried she has an STD. Exam does not show any lesions; the vagina and cervix look normal, without discharge. HIV, hepatitis, gonococcus, chlamydia are negative.

Challenge: What is the most serious potential diagnosis?

2 comments:

Crispin said...

Hey Craig, this is definitely "Cervical dysplasia." Cervical dysplasia is precancerous changes of the epithelial cells that line the cervix. Risk increases with multiple sexual partners, sex before age 18, childbirth before age 16, or a past history of STDs. Treatment is usually cryosurgery or conisation.

Craig Chen said...

yes! you are right!! nicely done
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Are We Uncomfortable Yet?

Postcoital bleeding is concerning for cervical cancer, especially in a woman who has never been screened and could be at risk for HPV.

Source: UpToDate.