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Why is there bleeding and pain during sex?

Q: My sister-in-law is 32 years old. She has a white discharge problem and gets pain and bleeding during intercourse. Yesterday she went to a doctor who said there is an ulcer in her uterus. What are ulcers and can they lead to cancer?

A:At the age of 32 years, bleeding after sexual intercourse can be because of conditions mainly relating to the cervix such as polyps and ectopy. The commonest cause is a minor condition called 'ectopy' (erosion) of the cervix. In this condition, there are some blood vessels on the cervix, which get the trauma during the intercourse, which makes them bleed. This should be easy to diagnose in the clinic using a commonly used device called 'speculum'. This can be treated either as outpatient procedure or under anaesthesia by burning (with electric diathermy) the blood vessels. It is a straightforward and minor procedure. Similarly if there is a polyp on the cervix that can be easily removed in an outpatient setting. It is also worth making sure that there is no ulcer on the cervix, which need to be biopsied to rule out anything sinister. There is no ulcer in the uterus (cavity of the uterus), which can cause bleeding after sexual intercourse. (Deep) Pain during intercourse can be because of a condition called endometriosis. This usually is associated with other symptoms such as painful periods, backache, pain during opening bowels etc. This needs a procedure (operation) called laparoscopy to diagnose. (Superficial) pain can be because of either vaginal infection of psychosexual causes. It is difficult to elaborate on these issues without any further information.

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