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HomeAnswersObstetrics and Gynecologybleeding after sexI have an ovarian cyst. Can it be ovarian cancer?

What are the signs and symptoms of ovarian cancer?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At May 27, 2024
Reviewed AtJune 6, 2024

Patient's Query

Hello doctor,

I am 29 years old and weigh 180 pounds. I am on Aspirin as a daily regimen. My question is, besides ovarian cancer, what could cause bloating, fatigue, distended abdomen, diarrhea, pain in the left leg, pain in both hips, and bleeding after sex with no pain? The bleeding after sex is just regular sex, nothing crazy, and it is never when the period has ended or is about to begin. This has been going on for a long time. Just recently, the bleeding after sex has been occurring, which seems like a red flag to me. Last year, an abnormal cyst was found in my cervix; after a transvaginal ultrasound done a few months later, it was no longer there. Kindly suggest.

Answered by Dr. Balakrishnan R


Welcome to icliniq.com.

I understand your concern.

I do not see anything suggestive of ovarian cancer in the history provided. Let me explain as follows:

1. Your age - At this age group, ovarian cancer is rare- except for a few sex cord type and germ cell tumors of the ovary. But they do not present like this.

2. Ovarian tumors never cause bleeding after sex.

3. Ovarian tumors are very silent. They present after many years. They are usually incidental findings on scans.

4. You have been having periods from 15 to 18 years. With your BMI (body mass index), I am sure they have not been regular. So you would be having no ovulation. Only after repeated trauma to the ovarian surface, during ovulation for many years, the site of trauma to the ovary undergoes malignant change. Once malignant, it takes 15 to 20 years to become clinically evident. So you have to reach 45 to 55 years of age to get that. So having completely ruled out any chances of Ovarian cancer, I feel the only possibility is a pelvic or vaginal infection; I am not talking about STD (sexually transmitted disease).

During sex, organisms like Trichomonas vaginalis, Chlamydia, or anaerobic bacteria can be transmitted from male to female genitals. This infection initially settles on the cervix, damaging the endocervical soft sensitive area. This area forms cysts in the cervix called Nabothian follicles; this is what you saw on the scan. Slowly, it may heal. If you have repeated infection at the same site, the cervix develops raw ulcers on the exposed or ectocervix. This is, again, an area that can bleed or throw out a drop or handful of fresh blood after any straining or sex. This will resolve on its own only if the trauma of sex and infection is stopped.

This infection moves up slowly over months and years into the uterus and the adjoining muscles and ligaments. So you will have white or yellowish or gray vaginal discharge with or without itching, foul smell, fatigue (as this is like any other infection draining your energy), feeling bloated, abdominal distention (all the infections alter your electrolyte balance and cause the fluid to move out of the vessels and collect in the abdomen), diarrhea (bowel will get irritated due to the infection in adjacent ligaments ), pain in legs (the nerves and vessels to the limb go under the same muscles and ligaments, they can be irritated or get compressed), radiating to hip. In addition, you can have spotting after periods, a throbbing sensation in the lower abdomen before periods, and a feverish feeling during periods. Less lubrication during sex, burning sensation in the vagina during sex, pain at the very end of sex when the penis touches the top of the vagina, periods of blood being darker and thicker than normal.

Usually, infection is mixed and not just due to yeast fungus, there will be a family of aerobic and anaerobic bacteria, all of which cannot be detected on culture. When one is treated and cleared, the other will grow and if not fully treated, it will regrow.

Before treatment, confirm that you are not pregnant. You and your partner can have it on the same day by both of you.

1. Tablet Fluconazole 150 mg stat one tablet after lunch.

2. Tablet Azithromycin 1 gm stat once a day an hour before food.

3. Tablet Secnidazole forte two tablets stat after dinner.

Later you have capsule Doxycycline 100 mg twice a day for one week, vaginal wash with cleanser twice a day, and vaginal pessary capsule Clingen forte or Candid -CL or Cansoft CL once at night for five nights. Your partner can have a local application of any antibiotic or antifungal cream. Candid B or Candiderma or Lobate GM) on the penis twice a day after washing for seven days. Do not have sex till the infection is fully gone. Treating it is important as delay may spread the infection inside and may affect both your and your partner's fertility in the future.

I hope I have clarified your query. Do write back if you have any more queries.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Balakrishnan R
Dr. Balakrishnan R

Obstetrics and Gynecology

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