Skip to main content
  1. Right Decisions
  2. Maternity & Gynaecology Guidelines
  3. Gynaecology
  4. Gynaecology guidelines
  5. Back
  6. Guidelines A-Z (all Gynaecology guidelines)
  7. Postcoital Bleeding (893)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Postcoital Bleeding (893)

Please report any inaccuracies or issues with this guideline using our online form

Post-coital Bleeding (PCB) is bleeding from the genital tract which occurs after intercourse. PCB after the menopause should be regarded as PMB and investigated as such. PCB can be associated with genital tract carcinoma but only a very few women presenting with this symptom have such serious pathology, the remainder having benign causes.

It’s worth noting that approximately 13% of women age 20-24 will experience PCB in any given year but in this age group only 0.002% of PCB is due to cervical cancer. 80% of such cancers are visible to the naked eye on speculum.

Causes

Cervical

  • Ectopy
  • Cervicitis
  • STI
  • Condyloma
  • Carcinoma (rarely)

Vaginal/Vulval

  • Trauma
  • Vaginitis
  • Tumours (rarely)
  • Vulval Dermatoses

Uterine

  • Endometrial polyp
  • Dysfunctional Uterine Bleeding (DUB)
  • Endometritis
  • Endometrial Hyperplasia/malignancy

Iatrogenic

  • IUCD/IUS
  • Following smear or treatment to the cervix
  • Hormonal contraception

History

The following aspects should be covered in the history:

  • nature and timing of bleeding
  • menstrual history
  • smear/colposcopy history
  • contraception history
  • sexual history for STI where appropriate
  • medical History e.g. bleeding diathesis, diabetes
  • medication e.g. anticoagulants, antibiotics with secondary candidiasis
  • dyspareunia

Examination and Investigation

  • Bimanual examination
  • Speculum examination
  • HVS
  • STI screen where appropriate (Chlamydia and gonococcus)
  • Cervical smear if due
  • Urgent colposcopy referral in the event of clinical suspicion of cervical malignancy
  • If no lower genital tract cause found, consider TVS in women over the age of 40

Referral guidance

  • Women with PCB should be referred to Colposcopy as ‘URGENT: Suspicious of cancer’ and seen within 10 working days if the appearance of the cervix on speculum examination is suspicious of or consistent with cervical cancer.
  • Women with PCB with abnormal cervical screening should be referred to Colposcopy as per usual colposcopy protocols. Those in whom screening is absent or overdue should have a cervical smear and be referred based on the smear result and clinical examination findings.
  • Women with persistent PCB aged less than 40yrs with a normal smear history and normal speculum examination should have a self-obtained vulvovaginal swab for chlamydia and gonorrhea NAAT testing and, where appropriate, treatment for genital tract infection.
    Consideration should be given to a change of hormonal contraceptive if relevant. A therapeutic trial of Relactagel (PV for one week after menses and repeated for 2 months) should also be considered. If these measures are ineffective, patients can be referred as ‘Routine’ for further assessment to gynaecology / colposcopy depending on local service provision.
  • Women over 40 should be referred as urgent and seen within secondary care services within 14 days (gynaecology / coloposcopy).
  • Patients are invited to participate in the national cervical screening programme from the age of 25. PCB is not an indication for a cervical smear in those aged less than 25.

Differences in age cut off and referral times in these recommendations compared to the RCOG / BSGE Abnormal Uterine Bleeding Covid Guideline should be noted. Differences are due to the current GGC service structure and Scottish Government treatment time targets which differ from the UK system.

Management (where cervical pathology has been excluded)

  • Treat infection
  • Remove endocervical polyps
  • Consider change of contraceptive formulation or method
  • Consider Relactagel®/Balance Activ® gel to acidify vagina. This should be used after menses,nightly for 1 week and repeated for 2 months. (NB contra-indicated if patient or partner has shellfish allergy).
  • Topical oestrogen preparations in the presence of atrophic vaginitis e.g oestradiol pessary (Vagirux® or Vagifem®) or Orthogynest® cream
  • Endometrial assessment in women over 40 in whom the above measures have failed.

Editorial Information

Last reviewed: 03/12/2020

Next review date: 31/12/2025

Author(s): Morton Hair.

Approved By: Gynaecology Clinical Governance Group

Document Id: 893