Clinical Question: Does bleeding after intercourse indicate cervical cancer?

Setting: Outpatient (any)

Study Design: Systematic review

Synopsis: The authors systematically reviewed several databases for English-language studies that reported or provided sufficient data to estimate the incidence or prevalence of postcoital bleeding. The authors do not report searching for unpublished data, independent and paired application of inclusion criteria, or paired data abstraction. Ultimately, they included 38 articles.

They found no studies that determined how often women presenting with postcoital bleeding were subsequently found to have cervical cancer. One mass screening study from Finland identified 2,648 women with postcoital bleeding, of whom 12 (0.45 percent) had invasive cancer at the time of presentation. Eight of the studies (including hundreds of thousands of women) evaluated women in community settings. The overall rate of complaints about postcoital bleeding is highly variable (0.7 to 9.0 percent); however, the large population-based studies report the prevalence at approximately 1 percent. It is not known how many women who experience postcoital bleeding seek medical care.

Sixteen studies reported the prevalence of postcoital bleeding in more than 47,000 women with invasive cervical cancer. The range of prevalence in these studies was 0.7 to 39.0 percent.

Bottom Line: In this systematic review, the rate of postcoital bleeding is highly variable and of uncertain significance. The best estimate is that approximately one out of 220 women with postcoital bleeding has invasive cervical cancer. (Level of evidence: 3a–)