Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Postcoital Bleeding in Primary Care ManagementPost Coital Bleeding (PCB) in Pre-Menopausal Women Protocol for GP Referral

Postcoital Bleeding in Primary Care Management

Post-coital bleeding

All Women with PCB should be screened for Chlamydia before referral and have a cervical smear if they do not have an in date smear (smear age 25-65 years)

NB; Most patients only need a routine referral if STI ruled out.  Cancer referrals are generally only necessary if suspicion after examination but check your local acute trusts cancer referral criteria.  Below is the ENHT referral criteria:


If cervix appears suspicious of malignancy on examination or if the pattern of bleeding is suspicious – refer under 2WW suspected cancer referral system.

Red flags:

  • Suspicious looking cervix
  • Suspicious vulval lesion
  • Suspicious vaginal mass

Take a cervical smear only if a woman is due or overdue for her regular screening.

No additional smear tests should be performed where the patient is not due a repeat.  Negative smear test should not stop referral.  Referral should not be delayed for results of smear when cancer is suspected.

What to include in referral:

  • 2 week wait referral form (if referring via suspected cancer pathway)
  • Letter detailing:
    • Frequency, severity and duration of symptoms
    • Current contraception
    • Smear History: regular, irregular, including date and result of last smear
    • Details of previous colposcopy, any treatments such as LLETZ/cold coagulation/laser
    • Relevant past medical/surgical history (including haematological/ coagulation disorders)
    • Current regular medication
    • Speculum findings (e.g. normal, ectropion, cervicitis, cervical polyp)
    • Investigation results: Chlamydia and full STI screening, pregnancy test

ROUTINE REFERRAL – 18 week pathway


Persistent PCB, 6 weeks and negative STI/Chlamydia

Persistent PCB, 12 weeks after treatment of STI/Chlamydia

Cervical polyps unable to remove in GP setting

Post coital or intermenstrual bleeding and abnormal appearance of cervix that is not suspicious of malignancy such as ectropion, inflammation.