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Advice on postcoital bleeding queried

Postcoital bleeding is not predictive of cervical cancer and

its presence alone does not

warrant investigation for the disease, a new GP study concludes.

NHS patient advice leaflets on cervical cancer recommend consultation with a doctor for any bleeding after sex, but the researchers said this should now be reviewed.

The study concluded it was 'inappropriate' to investigate all women with postcoital bleeding ­ on physical, psychological and economic grounds ­ because postcoital bleeding was so common.

Its prevalence in the community was around 5 per cent, but its positive predictive value for cervical cancer only 0.5 per cent, the systematic review of 38 studies concluded.

Dr Mark Shapley, a GP in Stoke-on-Trent and research fellow at the Primary Care Sciences Research Centre, University of Keele, said: 'This is something that's outdated and relates to clinical experience 30 to 40 years ago.'

Dr Shapley, whose study was published in June's British

Journal of General Practice, said that since then postcoital bleeding had become more common and cervical cancer detected earlier.

'Symptoms of postcoital bleeding are much more common than we realised. The predictive value is very, very tiny. GPs should certainly not refer every woman with postcoital bleeding.'

Instead they should examine the patient, make sure smears were up to date, consider STIs, and discuss the chances of cancer, he said.

Abnormal smears and pelvic speculum examinations should be referred, along with women with persistent symptoms which interfere with women's lives.

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