Intermenstrual and postcoital bleeding: structured assessment & when to refer (RANZCOG C-Gyn 6)

A woman tells you she bled after sex last night. Another mentions a day of spotting mid-cycle, between two normal periods. Neither symptom is dangerous in itself — but both are cervix-or-endometrium red flags that demand a structured search for a focal lesion. The skill is not to reach for the pill; it is to visualise the cervix, exclude infection, sample for screening, and know precisely when persistent symptoms cross the line into colposcopy or hysteroscopy.^[2][7]

Overview and definition

IMB and PCB sit inside FIGO System 1 as patterns that are abnormal by definition:^[1][2]

• Intermenstrual bleeding (IMB) — any bleeding between regular menstrual periods. A distinct, focal-lesion pattern.
• Postcoital bleeding (PCB) — bleeding during or after sexual intercourse, separate from menstruation. Another focal-lesion pattern.
• Unscheduled bleeding on hormonal contraception — a separate iatrogenic category (AUB-I in PALM-COEIN); managed differently.^[1][2]

Both IMB and PCB are SYMPTOMS — they describe what the woman experiences, not what is causing it. The examiner's trap is to treat them as diagnoses ("she has postcoital bleeding, give her a pill"). They are cervix-or-endometrium red flags that mandate a structured search for a focal lesion — cervical ectropion, polyp, cervicitis, CIN, cervical cancer, endometrial polyp, or endometrial cancer.^[1][3]

^{[2] [6] [7]}

References13ShowHide

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