Auditing the use of colposcopy versus general gynecology clinics to investigate women with postcoital or intermenstrual bleeding: a case for a new outpatient service.
OBJECTIVE
The aim of this audit was to determine whether initial referral to a general gynecology clinic (GOPD) or a colposcopy clinic is the most efficient means of managing women with postcoital (PCB) or intermenstrual (IMB) bleeding.


METHODS
A prospective audit of women with PCB or IMB was conducted. Sixty referrals from primary care were note-logged and alternatively allocated to either clinic. Data were collected by case note review.


RESULTS
Sixty women were referred for abnormal bleeding, 33 (55%) of which were seen at the GOPD and 27 (45%) at the colposcopy clinic. Investigations included Chlamydia testing, which was deficient in both settings, whereas ultrasound scans and hysteroscopies were performed in 9% of patients attending the GOPD compared with none in the colposcopy clinic. The most common finding at the GOPD was cervical ectopy in 14 (42%) patients. No abnormality was found in 9 (28%) patients. At colposcopy, 14 (52%) had no abnormality detected, whereas 8 (30%) had cervical ectopy and 3 (11%) had cervical intraepithelial neoplasia. There were no cases of malignancy found in this study.


CONCLUSIONS
Most patients with PCB and IMB will not have a serious abnormality. Our study proposes that a new PCB/IMB outpatient service can improve the efficiency of treatment of these women by providing appropriate guidelines to standardize their care.
Harry
Vanessa N
VN
Department of Gynecological Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK. v.harry@abdn.ac.uk
Cruickshank
Margaret E
ME
Parkin
David E
DE
D000328:Adult; D000554:Ambulatory Care Facilities; D003075:Coitus; D003127:Colposcopy; D005260:Female; D006176:Gynecology / Q000379:methods*; D006801:Humans; D008485:Medical Audit; D008796:Metrorrhagia / Q000209:etiology / Q000473:pathology*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis*; D014592:Uterine Hemorrhage / Q000209:etiology / Q000473:pathology; D014850:Waiting Lists; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000175:diagnosis*