In your young age, the possibility of cervical cancer as a cause of post-coital bleeding is very low.
In order to investigate the possible causes, the following items need to be looked into:
- How often does you menstruate? and are your cycles regular?
Is there any history of intermenstrual bleeding (bleeding in between cycles)?
- Are you having any pain during intercourse (dyspareunia)? Does it feel superficial or deep?
- Does the bleeding occur genuinely after sexual intercourse?
- For how long has the problem existed? Does it occur after each episode of sexual intercourse?
- Has you recently changed your sexual partner? and if so, have you had a full STI (sexually transmitted infections) screen?
- Do you have a history of STIs?
- Have you noticed any abnormal vaginal discharge? If yes, what's the color? and does it have a particular odor?
- Is there any associated abdominal pain or fever?
- Are you on combined oral contraceptive pills?
- Do you think you may be pregnant?
- Are there any urinary symptoms to suggest UTI (urinary tract infection), like burning, pain, frequency/urgency upon urination?
Possible causes in your case include:
Trauma during intercourse
Cervicitis refers to an inflammation of the cervix. Classically, watery and pus discharge are the presenting signs; however, postcoital bleeding is also associated with this condition. Acute cervicitis may be caused by infection with the following bacteria: Chlamydia trachomatis , Neisseria gonorrhea, Trichomonas vaginalis. Cervical infection must be diagnosed and treated early to prevent this infection from expanding upwards into the upper genital tract and lead to significant complications to include pelvic inflammatory disease, infertility, chronic pelvic pain, and increased risk for ectopic pregnancy.
Endometritis is an inflammation of the endometrium (the muscular layer of the uterus). Most women with symptomatic endometritis can present with heavy menstrual bleeding or intermenstrual bleeding; however, some women may initially complain of postcoital bleeding.
- Cervical Polyps
These are not an uncommon finding detected incidentally during a pelvic exam. They can cause postcoital bleeding secondary to cervical trauma with intercourse. Unlikely at your age.
- Cervical Ectropion
This condition occurs when the endocervix (the highest segment of the cervix) gets everted. As such, the cervix becomes closer to the vagina which increases the risk of bleeding with intercourse due to the friability of these cells. Most women with symptomatic cervical ectropion complain of vaginal discharge. This condition is often seen during adolescence, women taking oral contraceptive pills, and pregnancy.
You are advised to do the following:
1- Get a pelvic examination by a gynecologist to look for evidence of inflammation or infection, especially if you're also having pain during intercourse. If you're taking OCPs, discuss it with him/her.
2- urine pregnancy test
3- urine analysis and culture (to rule out a UTI)
4- vaginal swab (to rule out any STI)