Experiencing Increased Bleeding After Intimacy
A 30-year-old female has been using a contraceptive implant for the past year and a half without complications and has experienced her typically irregular and painful menstrual cycles. She has had a steady partner for roughly a year. Around 10 months ago, she noticed occasional blood after intimate encounters. The bleeding did not seem to correlate with different positions or the intensity of the activity. Afterward, she visited a health clinic for a comprehensive STD screening, which returned negative results. Following this, she consulted her general practitioner (GP), who recommended a colposcopy. This examination revealed a minor tear, which was treated with silver nitrate; however, the specialists suggested this wasn't likely the source of the issue, as everything else appeared normal. A cervical screening test was also conducted, yielding standard results. Recently, the situation has worsened, with increased bleeding both in volume and frequency. She is now experiencing bleeding after bowel movements and irregular bleeding between her periods, as well as consistent bleeding following any sexual activity. To investigate further, her GP suggested a colonoscopy, which also came back clear, although the preparatory process for the procedure was not very effective. The persistent bleeding has begun to significantly affect her daily life, prompting her to seek answers. She is feeling increasingly anxious about her health condition.
Answers (1)
7/8/2025, 12:50:50 AM
OpenHealth AI
Increased bleeding after intimacy, especially when accompanied by other irregular bleeding patterns, can be concerning and may stem from a variety of causes. Given your history and recent tests, it’s crucial to focus on understanding your symptoms and exploring potential underlying issues while managing your anxiety.
Explanation
From your description, it seems you've already taken several important steps to address the bleeding. Potential causes of increased bleeding could include:
- Cervical issues (such as cervical ectropion)
- Hormonal imbalances (perhaps related to the contraceptive implant)
- Endometrial issues (like endometriosis or polyps)
- Other gastrointestinal conditions (considering symptoms after bowel movements)
Since both your STD screenings and colonoscopy returned normal results, it suggests that infections and significant gastrointestinal issues may not be the sources.
Next Steps
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Symptom Tracking: Keep a detailed diary of your bleeding episodes, noting the timing, amount, and any associated symptoms, including pain. This data can help your healthcare provider identify patterns and possible causes.
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Follow-Up with a Specialist: Request a referral to a gynecologist who specializes in abnormal bleeding. Given your history and the ongoing issues, discussions regarding potential hormonal evaluations or imaging tests (like an ultrasound) may provide insights.
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Manage Anxiety: Consider discussing your anxiety and its impact on your health with a mental health professional or therapist. Managing stress and anxiety can be crucial in dealing with chronic health issues.
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Stay Informed: Educate yourself about conditions related to reproductive and gastrointestinal health, which can help you have informed discussions with your healthcare team.
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Hydration and Diet: Maintain a healthy diet rich in fruits, vegetables, and whole grains. Proper hydration and nutrition can support overall health, especially if you're dealing with discomfort.
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Seek Immediate Care: If you experience severe pain, heavy bleeding (soaking through a pad in an hour), or other alarming symptoms, consider seeking immediate medical care.
Your health concerns are valid, and understanding the underlying causes of your symptoms can help in managing what you're experiencing. Keep communicating openly with your healthcare providers about your symptoms and anxieties, as they can offer personalized guidance and treatment options.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.