Importance of Cervical Cytology in Patients with Postcoital Bleeding

INTRODUCTION: Our primary aim is to investigate the efficacy of cytology to detect preinvasive and/or invasive cervical pathologies in patients with postcoital bleeding and our secondary aim is to determine the management of postcoital bleeding with severe bleeding, abnormal cytology and normal cytology.
METHODS: Between January 2013 and September 2016, at Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, 317 patients who underwent colposcopy for postcoital bleeding were retrospectively evaluated and divided into 3 groups: without smear due to excessive hemorrhage (Group 1), with normal smear (Group 2) and with abnormal smear (Group 3). Biopsy results were compared between both groups and menopausal status. SPSS 15 was used for statistics. Sensitivity and specificity of pap smear were calculated for preinvasive and invasive pathology.
RESULTS: Menopause rate and age were not different between the groups. In the total patient group, it was observed that the highest rate of invasive cancer were in group without smear due to severe bleeding (group 1), and lowest rate were in group with normal cytology (group 2). The difference was statistically significant between the 3 groups (12.5%, 1.9% and 4%, respectively, p< 0.0001). Similar rates were also found in the premenopausal group (12.8%, 1.8% and 4.5%, respectively, p <0.0001). There was a statistically significant difference for invasive cancer incidence only between group 1-2 (p=0.0034), for pre-invasive/invasive cancer between both group 1-3 (p=0.004) and group 2-3 (p<0.0001). Sensitivity of smear was found to be 0.52 and specificity of smear was found to be 0.94 in detecting preinvasive/invasive cervical pathologies.
DISCUSSION AND CONCLUSION: Colposcopy is unnecessary in patients with postcoital staining-like mild bleeding, without visible lesion and with negative smear. However, colposcopic examination and biopsy are necessary for patients with bleeding during the examination or with abnormal smear results.