Bleeding – causes and symptoms
Bleeding: causes and therapy. Image: absolutimages – fotolia
Bleeding is the term used to refer to bleeding in women that occurs outside of normal menstruation. For example, if these occur during or after sexual intercourse, the fright is usually great – but in most cases, there is no need to worry, as it is often only a small violation of the tissue. If the bleeding occurs more frequently, however, a gynecologist should be consulted for a thorough clarification.
This also applies if the bleeding is very severe and / or accompanied by pain, because less often, e.g. even a cervical polyp or in case of emergency even cervical cancer may be the reason for the discomfort.
Frequently, vaginal bleeding also occurs outside the period, leading to anxiety and worry among the affected women. However, if a so-called “bleeding” occurs before or during sexual intercourse, in most cases a relatively harmless cause such as, for example, is present. a minor injury due to certain sexual practices. Less often, however, the bleeding can have a serious background. Therefore, it should always be taken seriously and in case of frequent occurrence without apparent cause necessarily be medically clarified.
Bleeding: causes and therapy. Image: absolutimages – fotolia
Bleeding after intercourse
In most cases, bleeding occurs after or during intercourse (GV) as a result of minor injuries to the tissues of the female genitalia. Because the tissue is very easily vulnerable in this area, especially on the cervix, since the blood vessels are just below the tissue surface. Possible reasons for bleeding therefore include, for example, severe mechanical stress from various positions in the traffic or certain sexual practices and utensils such as e.g. Vibration, as well as the penis size of the partner may be the cause.
Cervical cancer as a cause of bleeding
If bleeding occurs during or after sexual intercourse, malignant changes of the cervical tissue can be the cause in case of emergency. The so-called “cervix” (cervix uteri) is the lower part of the uterus, which opens into the vagina. The cervix uteri is an extremely sensitive area, which is particularly susceptible to cell changes. If these are malignant, physicians speak of a “cervical carcinoma”, which, according to the “German Green Cross”, represents the second most common malignant tumor in patients under the age of 45 worldwide and affects around 6000 women per year worldwide. Compared to many other cancers, younger women are more likely to be affected, with cervical cancer being most commonly diagnosed in women between 40 and 59 years of age.
The prerequisite for the development of cervical cancer is, according to current knowledge, a chronic infection with certain types of human papillomavirus, which are transmitted mainly in unprotected sexual intercourse. An HPV infection is not uncommon, but up to 80 percent of the population get stuck in the course of their lives (often without even knowing it) – but usually the viruses are fought by the body’s defense system within a short time.
However, in about one to two out of ten infections, the so-called “high-risk viruses” (e.g., HPV types 16 and 18) persist and permanently nourish themselves in the cells of the cervical mucosa. But even that does not always result in the development of cervical cancer. Instead, malignant cancer cells develop only when the infection becomes chronic and lasts for more than 12 months – which is true for only a few women.
Cervical cancer usually causes no symptoms at the beginning and is therefore often noticed relatively late. First signs may be bleeding after sex or outside the normal period, as well as a blood-smeared, often foul-smelling discharge from the vagina. Also typical are painful intercourse, in the advanced stage are also cross and pelvic pain, increased urinary tract infections, urinary or defecation complaints, blood in the urine, a sudden loss of weight and swollen legs by a lymph congestion possible.
If one or more of these symptoms occur, they should never be taken lightly, but should be consulted immediately. Because just the first signs such as outflow or bleeding outside the menstrual cycle are similar to the typical symptoms of more harmless diseases such. Inflammation – but can also point to a tumor.
It can therefore be life-saving to have them clarified in advance, in addition, it is also possible, for example, to clarify them. Infection or small benign growths if left untreated will become a protracted and very unpleasant burden and, in some cases, even lead to serious health problems.
If the cervical carcinoma is discovered at an early stage, there are usually very good chances of recovery. Accordingly, it is important for women to regularly take advantage of the gynecological screening test, which is available to every woman aged 20 or over once a year. In addition, the Standing Committee on Vaccination (STIKO) of the Robert Koch Institute has been recommending the so-called HPV vaccine for girls from the age of nine to protect them from cervical cancer for a few years already, before starting their first sexual contact. While this vaccine may protect against high-risk virus infection, there are other HP viruses that can also cause cervical cancer in rare cases. Therefore, experts advise again and again already vaccinated women, continue to make the appointment for cancer screening every year.
Bleeding through cervical polyp
Also a so-called “cervical polyp” can be the reason for a contact bleeding. This is benign mucosal proliferation in the cervix, which often occurs between the 40th and 60th year of life in women. The polyps may have a round or hourglass shape and be about two to three millimeters in size. Many women have no symptoms with a cervical polyp, but it can also lead to yellowish discharge from the vagina and bleeding contact. The proliferation is caused by an excessive division of the mucosal cells, which pile up and eventually bulge forward. What exactly comes to this increased division of the cells is not fully understood. It is believed, however, that the female sex hormone estrogen plays a key role, as especially women in menopause are affected by cervical polyps.
Emotional stress, a weakened immune system (due to existing illnesses or certain medications), poor intimate hygiene or an infection with human papillomavirus (HPV) can promote the development of a cervical polyp.
Bleeding after conization
Another cause of contact bleeding may be a conization. This is a mostly outpatient surgery on the cervix, in which a tissue cone (cone) from the cervix (cervix) is removed. The procedure is usually performed after a conspicuous Pap test, which is performed to detect and differentiate inflammatory changes in the cells, possible precursors of cancer and cancer cells. By removing the altered tissue is to be avoided accordingly, that develop the cell changes to cervical cancer.
The procedure is usually performed in a short general anesthetic or in regional anesthesia, more rarely under local anesthesia. Different surgical techniques (scalpel, laser, electric sling) are available for the removal of the tissue, but the method of first choice is currently the operation with an electrical loop (LLETZ = Large Loop Excision of the Transformation Zone, or LEEP = Loop Electrical Excision Procedure). Pain is usually rare after surgery, but slight bleeding or flushing may be possible as the surgical wound heals. In order to support the healing process and avoid infections, swimming, full baths, sauna, tampons and sexual intercourse should be avoided after the operation for about three to four weeks. In addition, the treating physicians should clarify whether and how physical stress should be reduced. If the contact bleeding does not stop during or after the sex even after this period, a doctor should be consulted in any case.
If the contact bleeding occurs during or after sex due to minor injuries due to certain sexual practices, utensils, etc., it can usually help, if it is done a little more cautious and is waived strong demands. Cervical polyps are usually twisted off and removed with a special surgical instrument (“forceps forceps”), followed by surgical removal of the tissue by scoring (curettage). If the bleeding can be seriously attributed to changes in the cervical tissue, treatment will be based on how far they have progressed. In cancer precursors, slight changes in the cells are often self-evident. Therefore, close to complete healing usually close-meshed checks at the gynecologist, which u.a. By means of a smear, mirroring of the vagina (colposcopy) and a special test for cell changes (“PAP test”), the healing process can be observed.
A detailed examination with a gynecologist can ensure the diagnosis. Picture: Kot63 – fotolia
If a cancer precursor requiring treatment is present, the doctor usually removes a cone-shaped piece of tissue from the cervix which contains the altered tissue (conization) as part of an operative procedure. This is usually done with a cervical lining of the cervix (cervical curettage) to prevent the spread of the malignant tissue to the inside of the uterus. The mucous membrane regenerates completely after this procedure and usually the affected women have no problem keeping children. Even in the very early stages of a cancer in the case of existing desire for children, a conization is considered, but here in addition always a Abschabung the mucosa of the cervix and uterine body (fractional curettage) is made. If the disease is already advanced, but usually a radiotherapy is necessary, this is often performed in combination with chemotherapy (chemoradiotherapy). (No)
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