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    leep procedure and cauterization
    lalalka1974 posted:
    I have been experiencing abnormal bleeding with clots up to a half dollar size since October and it is only after my boyfriend and are trying to be intimate or attempt to have intercourse. I start bleeding and it doesn't stop. I didn't think much of it although it never happened before but I thought he was just bigger than my past boyfriends, but on Dec 30 was the worst, it was all over him and me and dripping down my leg. I did not have a current OB/GYN so I found one who could see me on the 2nd. He couldn't really tell where the bleeding was coming from but did see it. He did silver nitrate to stop the bleeding. Well it didn't stop. I did have an ultrasound which showed a cyst and fibroid but I was assured they were normal and not causing the bleeding. Wednesday Jan 9 I ended up having the leep procedure and cauterization. I was told I might have some spotting but very minimal. The worst would be the clear discharge after with a foul spelling odor. I did not bleed after the procedure and all day Thursday. Friday night about 5 oclock I stood up from where I was sitting and blood just gushed out. I immediately called the dr on call and she said go to the ER and we may need to take you to the OR. I was examined and the dr on call did see the cauterization but no open/flowing bleeding anywhere so I was sent home. I am scared because I haven't stopped bleeding.
    Jane Harrison Hohner, RN, RNP responded:
    Dear lalalka: Sorry for the delay in replying. There are two basic culprits that can cause bleeding after sex: problems with the cervix and things that create bleeding from the uterine lining. Bleeding coming from the cervix could come from a cervical lesion---if one has had a recent normal PAP smear this is unlikely. An infection of the cervix (eg from Chlamydia) can make the cervix more "friable" (easier to bleed). In some women there is a normal enlargement of the area of glandular type tissue. These women can have bleeding when the cervix is sampled for a PAP smear. A polyp coming from the cervical canal may bleed only when the cervix is touched. Polyps of this type may be readily seen during a speculum exam.

    If the uterine lining is easily destabilized, having sex can prompt spotting or breakthrough bleeding. Some women will have this type of spotting if sex occurs during ovulation or right before menstrual flow is slated to begin. Women using hormonal forms of birth control may also have less uterine lining stability. Infections (eg Gonorrhea, Chlamydia) can destabilize the uterine lining causing erratic bleeding and bleeding after sex. Polyps of the uterine lining or uterine fibroids can create a focus for unstable uterine lining. If a woman has a history of missed periods, her uterine lining may be very thickened. In that situation spotting can represent small amounts of the lining being shed---just off the top layer.

    Lalalka, it sounds like your MD's decided that the initial cause of the bleeding was from the face of the cervix. Hence the LEEP, followed by the use of silver nitrate painted on the face of the cervix. When you went to the ER they could see the site of the LEEP and cauterization--but no active bleeding. Thus it is unclear to me if the gushing type of bleeding you had was from the cervix, or from the lining of the uterus. It is true that a fibroid does not usually cause a sudden onset of gushing bleeding; chronic heavy periods are more likely. An ovarian cyst can prompt erratic bleeding of the lining due to hormonal shifts. Sometimes this can present as gushing bleeding. Lastly, there may have been a deferred onset of bleeding after the LEEP. Some women can bleed almost as heavy as a period.

    I would strongly urge you to promptly return to the GYN who did your LEEP procedure. They know how much cervical tissue was removed. Some LEEPs remove only a thin layer of tissue, others go much deeper. I would consider this in the realm of a post-procedure follow up visit. They can give you the most "for sure" answer.

    In Support,

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