Is colposcopic evaluation necessary in all women with postcoital bleeding?

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 193; pp. 83 - 87
• Main Authors: Gulumser, Cagri, Tuncer, Aykut, Kuscu, Esra, Ayhan, Ali
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.10.2015
• Subjects: Adult; Biopsy; Cervical cancer; Cervical Intraepithelial Neoplasia - complications; Cervical Intraepithelial Neoplasia - pathology; Cervix Uteri - pathology; Coitus; Colposcopy; Cytology; Female; HPV; Humans; Linear Models; Middle Aged; Obstetrics and Gynecology; Papillomavirus Infections - diagnosis; Patient Selection; Postcoital bleeding; Retrospective Studies; Risk Factors; Smear; Smoking; Uterine Cervical Neoplasms - complications; Uterine Cervical Neoplasms - pathology; Uterine Hemorrhage - etiology; Vaginal Smears; Smear; Postcoital bleeding; Colposcopy; Cervical cancer; Cytology; HPV
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2015.06.012

Abstract Objective To evaluate what extent postcoital bleeding (PCB) is an indicator of cervical cancer (CIN2 (+)). Methods This is a retrospective cohort study. Between 2007 and 2013, amongst all referred patients, a total of 1491 consecutive women who had both conventional cytology and cervical biopsy were enrolled in the study. Of those 237 women have PCB, according to biopsy results, subjects were divided into two groups: CIN1 (−) and CIN2 (+). Multiple logistic regressions was used to construct a model to predict the occurrence of CIN 2 (+) based on age, menopause, marriage status, smoking, PCB, HPV and cytology. Results Among the all women with CIN 2 (+) colposcopy guided biopsy result, PCB was 13.1% (53/406). The relationship between biopsy results and age, parity, menopausal status, marital status, smoking, presence of PCB, HPV DNA, and cytology is statistically significant ( p = 0.012, p = 0.001, p = 0.023, 0.013, p > 0.001, p = 0.038, p < 0.001, p < 0.001, respectively). According to regression analysis only smoking, HPV (+) and abnormal cytology increase the probability of CIN2 (+); 1.687 times ( p = 0.018), 4.065 times ( p < 0.001), 5.787 times ( p = 0.001) respectively. Having PCB only does not indicate an increased risk of CIN2 (+). Conclusion Colposcopic examination and biopsy should be performed only in the situation where women have PCB and any of the following: smoking, positive HPV, or abnormal cytology.