Prepare yourself for overshare (which in my mind doesn’t really exist, but in medical school we were always taught in communication skills workshops to ‘fire a warning shot’ so don’t say I didn’t tell you…)
I went for a smear test yesterday, cos you know, got to practice what you preach and all that. And as the nurse finished taking the sample I saw her putting the sampling brush into the pot and I saw there was blood on it. I was not having my period so why was there blood? It’s actually incredibly common to have bleeding after a smear test and loads of people freak out and think it means the worst. Well, in the vast majority of people, myself included it’s due to a completely benign condition called an ‘ectropion’. In fact, I don’t know why I even just referred to it as a ‘condition’, because it’s actually a variant of normal.
Time for some more terrible gynaegeek artistry... The doughnuts at the bottom are the cervix being viewed end on, as it is seen during a speculum examination (aka 'the fanny clamp of death' as my patient called it last week. NB. she agreed afterwards this was a gross exaggeration and I was actually really gentle...:-D)
An ectropion is an exposed area of the glandular lining of the inside of the cervix. Normally the outer cervix is covered entirely with a smooth lining that’s quite tough and similar to the skin lining the inside of the vagina. But the glandular lining is a bit rough and more fragile. Its most common to have an ectropion when taking the combined oral contraceptive pill, or during pregnancy, but loads of women just have one for no particular reason. They’re not associated with a higher risk of having abnormal smears, or with any other disease. They can be bloody annoying however…literally. They can bleed on contact, such as during my smear test, or during/after sex due to the fragile nature of the glandular lining. It doesn’t mean anything is wrong, it’s just that lining isn’t really designed to be exposed in such a way. Lots of people have an ectropion and never know because they don’t all bleed. If you do have one it can go away on it’s own. But if the bleeding is really annoying there are things that can be done to treat this, such as burning away that top layer of skin. We generally don’t really recommend doing that unless it’s really problematic.
Having said that, bleeding after sex is abnormal until proven otherwise. Not all bleeding after sex is caused by an ectropion, and other more serious causes include infections and abnormal cells on the cervix. So please go and see your GP if you’re getting problems with bleeding and they can easily check your cervix and decide whether you need to come to the Gynaecology clinic for further assessment.