Investigations of other symptoms: vaginal discharge and deep dyspareunia

Cervical screening and women with symptoms that may be associated with cervical cancer

The Cervical Screening Test (CST) is for asymptomatic women, aged 25–74, who are participating in the National Cervical Screening Program. Women with symptoms suggestive of cervical cancer require diagnostic testing at any age and not ‘cervical screening’.

The vast majority of symptomatic women, especially younger women, will NOT have cervical cancer and benign gynaecological causes are far more common.

Young women with postcoital or intermenstrual bleeding are far more likely to have a benign cause eg: chlamydia infection or bleeding related to hormonal contraception.

Abnormal vaginal bleeding is the most common symptom of cervical cancer and is covered in detail in Investigation of abnormal vaginal bleeding.

Vaginal discharge and/or deep dyspareunia are commonly due to benign gynaecological conditions and should be investigated appropriately and, if necessary, referred for gynaecological assessment. In the absence of bleeding, vaginal discharge and/or deep dyspareunia, may very rarely be the initial presentation of cervical cancer.

If due for cervical screening, then a routine CST would be most appropriate rather than a co-test (HPV and LBC) for these women. Co-testing is not indicated in the vast majority of women presenting with vaginal discharge and/or dyspareunia.

• Unexplained persistent unusual vaginal discharge, especially if malodorous and blood-stained, may be associated with a cervical cancer and should be investigated by clinical examination of the cervix, a co-test and tests for a genital infection:
  • if the co-test is abnormal the patient should be referred for colposcopy;
  • even if the co-test is negative (no HPV detected and LBC normal), referral for gynaecological assessment should be considered;
  • if a CST was recently performed with a low-risk result, consider referral for gynaecological assessment without a co-test.
• The investigation of unexplained persistent deep dyspareunia (in the absence of bleeding or discharge) should include a CST if due for routine screening and referral for gynaecological assessment should be considered.

Women who present for a routine Cervical Screening Test (CST) and who have vaginal discharge or deep dyspareunia, should in the first instance have a CST.

Consensus-based recommendation

REC18.9: Women with abnormal vaginal discharge and/or deep dyspareunia Almost all women with vaginal discharge and/or deep dyspareunia have benign gynaecological disease. They should be investigated appropriately, and if due for cervical screening a routine CST should be performed (rather than a co-test).

Consensus-based recommendation

REC18.10: Women with unexplained persistent unusual vaginal discharge In women of any age, unexplained persistent unusual vaginal discharge, especially if malodourous or blood stained, should be investigated with a co-test (HPV and LBC) and the woman should be referred for gynaecological assessment.

Consensus-based recommendation

REC18.11: Women with unexplained persistent deep dyspareunia Women with unexplained persistent deep dyspareunia in the absence of bleeding or vaginal discharge should have a CST if due and referral for gynaecological assessment should be considered.

Persistence of any unexplained gynaecological symptoms always warrants further investigation and referral as appropriate.

Author(s):

• Professor Ian Hammond — Contributor
• Professor Marion Saville — Author
• Professor Deborah Bateson – Author
• Dr Vivienne Milch – Co-author
• Cancer Council Australia Cervical Cancer Screening Guidelines Working Party — Co-author

Back to top