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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Lower Abdominal Pain And Bleeding Immediately After Intercourse?

I had a laparoscopic total hysterectomy (uterus and cervix only) on 29.04.2016, (9 weeks post op as of 06.07.2016) and am feeling a pinching/stinging pain where the vaginal cuff should be occasionally. I am also bleeding immediately after intercourse, which can be painful (bright pink, enough to need a panty liner but not a sanitary towel) for a few hours, and suffering moderate lower abdominal pain for at least 48 hours after sex. I went to my gp, as have been discharged by my gynae consultant following the surgery, and was prescribed metronidazole and doxycycline for one week, which has now finished (also caused a thrush infection and have taken fluconazole X2 treatments) my gp said the cuff appears to be healing normally, and took blood, a urine sample, and vaginal swabs, all of which came back negative for infection/s.t.i s. The gp thinks I may have pelvic inflammatory disease from the surgery, and is treating it as such. However, I feel it is unilikely to be an infection, as I have no foul smelling discharge (although the amount has increased slightly, and is occasionally beige or urine coloured.) Could it be granulation of the vaginal cuff, and if so, will it clear on its own without the need for silver nitrate or cauterisation?
Thu, 17 Oct 2019
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General Surgeon,  's  Response
Hi,

The reasons for bleeding after intercourse are often due to benign conditions like cervical polyp, cervicitis (infection of the neck of the womb) cervicalal ectropion (epithelium lining cervical canal protrudes out a bit) vaginal atrophy, foreign body etc.

Sometimes it is due to causes of concern like precancerous lesion of the cervix or cervical/ vaginal cancer. Since you have been examined by doctor and also had colposcopy most of the benign causes are obviously excluded.

Do you have regular cycles? Do you have unprovoked bleeding in between cycles? Do you have any bleeding disorders? Are you on blood thinning medications? Are you on oral contraceptive pills?

In this case sometimes there is cervical ectropion due to estrogen content in pill. This epithelium is delicate. It can be injured during intercourse causing bleeding. Though rare it is important to exclude precancerous/ cancer lesions by biopsy. Let us wait for the result.

Please note that in more than 50% of cases no cause will be identified after all these investigations. In such a scenario the bleeding usually resolves in few months time.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Iven Romic Rommstein, General Surgeon
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What Causes Lower Abdominal Pain And Bleeding Immediately After Intercourse?

Hi, The reasons for bleeding after intercourse are often due to benign conditions like cervical polyp, cervicitis (infection of the neck of the womb) cervicalal ectropion (epithelium lining cervical canal protrudes out a bit) vaginal atrophy, foreign body etc. Sometimes it is due to causes of concern like precancerous lesion of the cervix or cervical/ vaginal cancer. Since you have been examined by doctor and also had colposcopy most of the benign causes are obviously excluded. Do you have regular cycles? Do you have unprovoked bleeding in between cycles? Do you have any bleeding disorders? Are you on blood thinning medications? Are you on oral contraceptive pills? In this case sometimes there is cervical ectropion due to estrogen content in pill. This epithelium is delicate. It can be injured during intercourse causing bleeding. Though rare it is important to exclude precancerous/ cancer lesions by biopsy. Let us wait for the result. Please note that in more than 50% of cases no cause will be identified after all these investigations. In such a scenario the bleeding usually resolves in few months time. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Iven Romic Rommstein, General Surgeon