Sun | Jul 21, 2019

Dear Doc | I bleed whenever I have sex

Published:Sunday | November 18, 2018 | 12:00 AM


Q Dear Doc, I am a 27-year-old woman who is in a committed relationship. Once per year I get a Pap smear done. This year I haven't done so yet. The last Pap done was okay. I've been noticing for several months now that when I have sex I bleed, but it's not much blood and it's not deep-red. I am currently taking minigynon (six months). I am concerned about the bleeding. It happens even if I use a condom. Sometimes there is discomfort in my abdomen during sex. Thanking you in advance for your response.

A What you described is called post-coital bleeding. Post-coital bleeding refers to spotting or bleeding unrelated to menstruation that occurs during or after sexual intercourse. There are many possible causes for this, and the most serious cause is cervical cancer. With you having a normal Pap smear within the past year, I can safely say that that is not the cause of your post-coital bleeding.

However, there are numerous other causes, and these are likely more applicable to you. These include cervical lesions, or infections which are the most common non-cancerous conditions associated with post-coital bleeding. Such conditions include:

- Cervical ectropion: Ectropion occurs when there is eversion of the endocervix, which simply means the cells that are usually inside the cervix (endocervix) become exposed to the vagina. It is also called cervical ectopy, or erosion. Cervical ectropion is also common in women taking combined oral contraceptives, which minigynon is.

- Cervical polyps, which are non-cancerous growths.

- Cervicitis: Cervicitis is associated with post-coital bleeding and also an abnormal vaginal discharge. Common causes of cervicitis are chlamydial infection and bacterial vaginosis.

The best way to correctly diagnose the cause of your post-coital bleeding is by seeing your gynaecologist and having the cervix examined. In each of these conditions, bleeding is often reproduced in the examination room when the abnormality is touched with an instrument.

If physical examination reveals an abnormal cervical discharge or vaginal discharge, tests for chlamydia and gonorrhea, as well as evaluation of vaginal fluid for trichomoniasis and bacterial vaginosis will be done.

Any infection will be treated, as appropriate, for whichever infectious organism that is identified.

Cervical ectropion does not require treatment, except in the case of excessive mucous discharge or spotting that is particularly bothersome. In such cases, treatment may take the form of either using an acidifying agent, cryotherapy or electrocautery.

Cervical polypectomy, the removal of a cervical polyp, is performed for polyps that are symptomatic (causing bleeding or excessive discharge), large (greater than three centimetres), or appear atypical. Removal can be done by grasping the polyp with forceps and twisting it off. Cauterising the base prevents bleeding and reduces the chance of recurrence.

In many women, the symptom resolves spontaneously.


Painful dry eyes


Q Dear Doc, I am having really painful, dry eyes. I have been to over five opticians and two opthalmologists, yet my problem persists. I have also been to my general practitioner. At the moment, I feel frustrated. I wear tested glasses and my last pair is just a year old. I keep having the problem regardless of the age of my glasses. I also use different brands of eye drops as prescribed. I need help!

A Dry eyes, the medical term for which is keratoconjunctivitis sicca, happens when your eyes either do not make enough tears or the tears that they make evaporate (go away) too quickly. This results in your eyes feeling dry and irritated.

Many people have dry eyes; however, a few people with dry eyes might have another disease called Sjogren's syndrome. Some medications can also cause dry-eye symptoms or make them worse.

Artificial tears are the main treatment for dry eyes. They aim to keep the eye moist and help improve the symptoms of dry eye. You can buy artificial tears without a prescription. They come in the form of liquid, gel, or ointments.

A recommended starting dose for artificial tear administration is one drop in each eye, four times per day. Most patients often begin to notice improvement within a few days of initiating treatment but it can take up to three to four weeks to notice a significant change in symptoms. If the symptoms persist, the frequency of artificial tear use can be increased to as frequently as every hour. Artificial tear gels and ointments are an option if you feel that the eye drops are not providing enough relief.

Dry eyes are a chronic condition and require chronic treatment, and most patients are not advised that they will need to use artificial tears for relief of dry-eye symptoms indefinitely. They work only as long as you keep using them.

Other things you can do to help improve your symptoms include:

- Try to blink a lot (not stare too long), especially when you are using the computer. This can help to keep your eyes moist.

- Avoid excess air conditioning as much as you can, as well as avoid sitting directly in the flow of cold air, for example, a fan.

- Avoid smoke and smoky air.

If your dry eye does not get better in three to four weeks, your ophthalmologist may do more tests and might suggest other treatments. These include prescription eye drops or ointments, special glasses or goggles, oral medicines (pills), or surgery.