Patient: Hi, my girlfriend had sex with me 2 weeks ago as soon as we woke up. She has been bleeding everyday for a month since. I fear this could be linked to an STI. She currently has a coil and I know that can give problems.. What are your thoughts?
Doctor: Hello,Thanks for the query to ATD for an opinion,If the bleeding has started after you both having sex together and the coil has also been placed around that time, then there are two possibilities, one that she may have developed cervical erosions or vaginitis which can be the cause of bleed which is cervical in nature and not uterine. Secondly it is generally seen that irregular and prolonged spotting may occur in most women who have switched to coil IUD (MIRENA mostly as i think) recently and this bleeding can be controlled with antifibrinolytics easily. However if there is an accompanied infection then the spotting may be prolonged.It is suggested that she should get a per speculum examination done to rule out cervical erosions and also a concomitant high vaginal swab for culture to rule out any infective cause which if found can be easily treated with antibiotic pessaries or oral medication. Your concern about an STI could be a possibility but considering that she has no foul smelling discharge, increased frequency of urine, low back ache, fever, abdominal pain, so in such case, STI seems unlikely.So please visit a gynecologist for an examination and please follow up with reports.I hope i have answered your query in detail,Wishing you good health,Regards
Comments / Follow Ups
Patient: Thank you for your help.
Sorry I didn’t type the most accurately.
We had sex 4 weeks ago as soon as we woke up. She had the coil fitted about a year ago.
As soon as we had sex the bleeding started and hasn’t stopped since, not heavy just enough to notice. I have been told that if it was an STI the bleeding would not be for a full month, is this correct?
We have both not had unprotected sex previously but of course these questions have to be asked because of the bleeding.
Doctor: Yes, the bleeding doesn’t last for a month in case of STI ideally, infact there is no bleeding in STIs and never form a feature of presentation , its always a abnormal discharge.
Secondly its likely due to the progesterone effect of the coil itself on the endometrium leading to irregular shedding and also due to softening of cervix, leading to erosion and darkish brown discharge post frictional injuries likely during unprotected intercourse. Hence its always better to get a per speculum examination done in her case as of now. There may be an IUD thread which may be causing local cervical erosion and is the cause , one may get to know after the examination, so proceed for it please.
Patient: Thank you so so much for your help. My girlfriend is going to ask for the coil to be removed as it is clearly causing problems and also going to ask for a smear test despite being 22 she has a history of cancer in her family. I was worried that the bleeding was down to an STI but after speaking to yourself my mind is at rest. Than you so much.
I don’t think coil would be needed to be removed because it is a common feature to experience such spotting and inter menstrual bleed for 1-2 months in some women as it takes time for the progesterone levels to build up and this bleeding can be controlled with antifibrinolytics easily unless the thread is causing erosions over cervix. Even in that case the thread can be shortened. Anyhow she should get herself examined and then the decision can be taken by her gynecologist.
Patient: Thanks Doctor.
She has had it for a year now though… Do you not think that would be sorted by now?
We have had sex with it before many a time but this is the first time that has bled everyday for a whole month. To me it sounds like a tear and not an infection BUT I am not a Doctor! 🙂
Doctor: If she has had it for a year then coil is not the reason, it is likely cervical erosions accompanied with vaginitis. The final word can be given by her gynecologist after a local examination, so please get one done soon.
Keep me posted. 🙂
Patient: Oh right, ok. But you would rule out the STI?
Patient: What about a tear? Her only symptom is blood everyday for a month as I stated. No discharge etc…
Patient: The sex also hurt during the time we did it as I stated first thing in the morning.
Doctor: Vaginitis can cause vaginal abrasions if you have been continuing sex regularly and those can be painful.
Patient: Very nervous about the chance she has an STI 🙁 hope she doesn’t…
Doctor: In my capacity here i can offer you differential diagnoses based on history provided but the fact can be deduced only after an exam. So be positive and lets see the results.