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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Textbook/Obstetrics and gynaecology/Intermenstrual and postcoital bleeding/Rapid
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Intermenstrual and postcoital bleeding

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate pregnancy-related or major bleeding

Collapse, severe pelvic pain, heavy ongoing loss, fever, sexual injury or possible pregnancy with bleeding can represent ectopic pregnancy, haemorrhage, infection or trauma and needs urgent care.

Action: Assess ABCDE, obtain pregnancy status, quantify loss and pain, involve acute gynaecology or sexual assault services as indicated, and defer routine cervical or contraceptive review until immediate threats are addressed.

Synopsis

Localise bleeding between periods or after sex, exclude pregnancy and infection, identify cervical and endometrial warning features, and route persistent symptoms to direct examination, hysteroscopy or urgent cancer assessment.

  • Clarify whether blood is vaginal, cervical, uterine, urinary or rectal; timing noticed after sex does not prove the cervix is the source.
  • Ask last normal period, pregnancy possibility, contraception and adherence, pain, discharge, sexual exposure, trauma, menopause status, anticoagulants and cervical screening history.
  • Offer a pregnancy test whenever pregnancy is possible and interpret an early negative result cautiously; a positive result with symptoms requires pregnancy-location assessment.

Key red flags

Positive or uncertain pregnancy testing with unilateral pain, shoulder-tip pain, syncope or bleeding requires urgent ectopic pregnancy assessment.

Suspicious cervix

Irregular, ulcerated, nodular, friable or spontaneously bleeding tissue requires urgent diagnostic referral rather than screening reassurance.

Investigation priorities

01
Pregnancy testFirst step

Detect pregnancy-related bleeding and prevent unsafe endometrial investigation or prescribing.

Management branches

Initial sequenceLocalise, test pregnancy and inspect the cervix

Bleeding is reported between periods or after penetrative sex.

  1. Clarify source, timing, recurrence, amount, pain, discharge, menopause, contraception, medicine exposure and consensual sexual context in privacy.
  2. Offer pregnancy testing and relevant STI NAAT, then perform consented external and speculum examination when bleeding persists or cervical disease is possible.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom