title: Auditing the use of colposcopy versus general gynecology clinics to investigate women with postcoital or intermenstrual bleeding: a case for a new outpatient service.
abstract: 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.
authors.affiliation: Department of Gynecological Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK. v.harry@abdn.ac.uk
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Harry
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Cruickshank
authors.forename: David E
authors.initials: DE
authors.lastname: Parkin
mesh_terms: 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*