Brief Answer:
There are many causes of post-coital bleeding that need to be investigated

Detailed Answer:
Hello and I hope I can help you today.

There are many reasons why a woman may have irregular bleeding after having a baby. It is normal to bleed for 6-8 weeks especially if you are not breastfeeding. Vaginal bacterial infections can definitely cause post-coital bleeding, but usually they are treated with an antibiotic called Metronidazole. If the bacteria was in your urine though, it probably is not the cause of your vaginal bleeding.

You may be bleeding from your cervix because of a condition called ectropion on your cervix. Ectropion is a condition where the inner glands of the cervix grow on the outer surface. Your cervix may have healed differently after childbirth to give you this condition. You also could have scarring on your cervix left from when you were in labor (if you were). Your doctor who did your PAP smear should have noticed if you had this but it may be worth double-checking with your provider. I also do not know if you are using any type of contraceptives, but the pill and the IUD can both cause post-coital bleeding as a side effect.

However, there is a rare but serious condition called GTD (gestational trophoblastic disease) where placenta-like tissue can grow after delivery. It can cause persistent bleeding after delivery and your ultrasound at 7 weeks postpartum may have been too soon after delivery to see it. However, this tissue produces pregnancy hormone, so an easy way to rule that out is to take a pregnancy test.

In order to give you a thorough answer it would help me to know:

1. Are you breastfeeding?

2. Do you get your period?

3. Are you using any form of contraception?

4. Do you have any other irregular bleeding, or is it only postcoital?

5. Why did you have a c-section at 8 months? Any complications with the pregnancy?

6. Have you had any hormonal testing?

I hope my limited discussion of the possibilities for the cause of your condition was helpful. If you could please provide the above information for me- I will be able to give you a better opinion of what is going on.

Thanks, and i hope this preliminary discussion was helpful, Dr. Brown

---

Brief Answer:
Thank you for the additional information- here are my suggestions.

Detailed Answer:
Thanks for getting back to be- this really helped to clarify your situation.

I doubt this is due to an infection, or any hormonal problems, now that I know your history.

The mini-pill can cause irregular spotting and certainly could have made you susceptible to bleeding triggered by jostling of your uterus during sex. Breastfeeding causes low estrogen levels in postpartum women, which can cause vaginal dryness and atrophy similar to women who are menopausal. This can make the vaginal skin delicate, which can cause it to bleed sometimes from chafing during sex. If you found sex uncomfortable when you were breastfeeding, this is the most likely explanation.

I think this is the most likely cause of your postcoital bleeding, and it should get better after using a combination birth control pill. However the Minastrin you are taking is also a very low estrogen pill, so it may not replenish enough estrogen to improve your cycle control and bleeding. You may want to try another brand of pill with more estrogen if this one does not give you regular, light periods as it should.

I would try the Minastrin for three months and see how it goes. If at three months you still are having postcoital bleeding, return to your GYN for examination (it will be a year since your delivery anyway) and ask him/her if you have ectropion on your cervix or if your cervix is "friable" (that's the term doctors use to describe a cervix with delicate skin that bleeds when touched). If you bled from your last Pap smear, this is another possibility for your diagnosis. Then try changing to a different birth control pill with a little more estrogen and that should help.

In the meantime, as long as your PAP and HPV test were negative, there is no need to worry about cancer as a cause for all this. I am sure after a few months on the combination pill, your bleeding will get better. In the meantime, if you notice vaginal dryness, using a lubricant may help to reduce chafing and chances of post-coital bleeding in the meantime.

I hope this answered your question adequately and that my advice was helpful.

If you need anything further, please do not hesitate to ask.

Best wishes, Dr. Brown

---

Brief Answer:
You are welcome!!!

Detailed Answer:
Thanks for your kind reply. If you don't mind- if you had a positive experience, please leave a star review for me on the Healthcaremagic website. It will help more patients reach me. Take care, and thanks again, Dr. Btown

---