CLINICAL ARTICLE Evaluation of women presenting with postcoital bleeding by cytology and colposcopy Afsaneh Tehranian a, ⁎, Negar Rezaii a , Mitra Mohit b , Bita Eslami a , Malihe Arab c , Zahra Asgari a a Department of Gynecology and Obstetrics, Roointan-Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran b Department of Gynecology and Obstetrics, Azad University of Medical Sciences, Tehran, Iran c Department of Gynecology and Obstetrics, Shahid Beheshti University MC, Tehran, Iran abstract article info Article history: Received 27 September 2008 Received in revised form 19 November 2008 Accepted 3 December 2008 Keywords: Colposcopy Cytology Postcoital bleeding Objective: To evaluate women with postcoital bleeding (PCB) by clinical examination, cytology, colposcopy, and histopathology. Methods: A cross-sectional study of 123 women with PCB, who were referred to the Colposcopy Clinic of Arash Hospital, Tehran, over a 2-year period. Results: Clinical examinations revealed cervical polyps in 18 women and ectropion in 14. Cervical cytology identified 13 patients with atypical squamous cells of undetermined significance, 2 with atypical glandular cells, 4 with low-grade squamous intraepithelial lesions, and 3 with high-grade squamous intraepithelial lesions. Colposcopy indicated invasive cancer in 1 patient. Transitional zones appeared normal in 39.8% of the cohort, were atypical grade 1 in 33.3%, and atypical grade 2 in 4.9%. Fourteen abnormalities were detected at histology, including 1 squamous cell carcinoma, 1 low-grade glandular neoplasm, 9 cervical intraepithelial neoplasia (CIN) grade 1, 2 CIN grade 2, and 1 CIN grade 3. The sensitivity and specificity of cytology were 50% and 86.5%, respectively. A total of 21.4% of abnormal pathologies were missed using colposcopy, which had a sensitivity of 79%. Conclusion: Because of its higher sensitivity, colposcopy can be recommended for the investigation of persistent PCB, even in the presence of normal cytology. Crown Copyright © 2008 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. All rights reserved. 1. Introduction Postcoital bleeding (PCB) is defined as bleeding occurring during or immediately after sexual intercourse at a time separate from menstruation. It is a common, multifactorial, gynecological symptom [1]. In a review of PCB, the point prevalence of PCB among women in the community ranged from 0.7% to 9% [2]. Occasionally, it is the first presentation of cervical cancer, and the prevalence of PCB in women with cervical cancer has been reported to vary between 0.7% and 39% [2]. The incidence of cervical intraepithelial neoplasia (CIN) in women with PCB has been reported to be approximately 17%, and the in- cidence of cervical cancer is 3% in this group [1]. It has been reported that all symptomatic women with cervical cancer, who were younger than 65 years, had PCB [3]. The current management of PCB is not consistent, and PCB alone is not currently an absolute indication for colposcopy. Colposcopy is an important component of the cervical screening program, but there are several disadvantages for patients with PCB undergoing colposcopy screening; for example, patient anxiety and undue distress, use of valuable colposcopy time, and the progression to unnecessary in- terventions [4]. In our center, we use cervical cytology to evaluate women with PCB, and colposcopy is usually performed when there is abnormal cytology. However, some studies have shown that normal cytology can be accompanied by abnormal and even invasive pathologic evaluation [5,6]. The aim of the present study was to evaluate women with PCB using clinical examination, cytology, colposcopy, and pathologic findings. 2. Materials and methods Data were collected from 123 women with PCB who were referred to the Colposcopy Clinic of Arash Hospital from 2 teaching hospitals between September 2005 and March 2007. All patients had been seen by their general practitioner before referral, and if the bleeding was due to vulvovaginitis, cervicitis, or polyps, they were treated. In cases of resistant PCB or suspicions of malignancy, the patients were referred to the Colposcopy Clinic. Exclusion criteria were pregnancy, previous diagnosis of preinvasive or invasive cervical lesions, and prior total hysterectomy. The study was approved by the Ethics Institutional Review Board of the Tehran University of Medical Sciences, and informed consent was obtained from the participants. All participants had PCB and were evaluated by clinical examination, cytology, and colposcopy-directed biopsy. Information regarding the risk factors for cervical cancer, such as age at first intercourse, smoking, number of partners, parity, and contraceptive history were obtained from the participants. Clinical examination, especially careful inspection, was initially performed International Journal of Gynecology and Obstetrics 105 (2009) 18–20 ⁎ Corresponding author. Tel.: +98 21 77883283; fax: +98 21 77883196. E-mail address: afsanehtehranian@yahoo.com (A. Tehranian). 0020-7292/$ – see front matter. Crown Copyright © 2008 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. All rights reserved. doi:10.1016/j.ijgo.2008.12.006 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo