Irregular vaginal bleeding may be the first sign of cervical cancer or lining of the uterus and, therefore, recurrent bleeding between periods requires medical assessment particularly after the age of thirty-five. The first symptoms of cervical cancer include post-coital bleeding (bleeding after sexual intercourse) and blood stained vaginal discharge. The average age of presentation of cervical cancer is 45 and for endometrial cancer it is 55. Ovarian cancer may present with enlargement of the abdomen or abdominal pain. Vulval cancer may present as a swelling or an ulcer on the vulval skin.

It must be emphasised that most patients presenting with any of these symptoms will not prove to have cancer. Persistence of symptoms indicates the need for increased vigilance. It is for the doctor to assess from the story and examination findings, which investigations, if any, are required.

Women's Health

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