Post-coital spotting-need second opinion?

I am a 28 y/o female, no children, non-smoker, healthy diet and regular exercise.  I do not have HPV or any STIs.  I have been using the pill for almost 2 years with no issues.  

I began having some very light spotting after a session of rougher than usual sex with my husband about 4 weeks ago.  There was some very light pink when I wiped afterward, which disappeared within 20 minutes.  No other issues.  I had some darker brownish spotting (also very light) 2 days later after masturbating.  We were more careful after this and I had no spotting after sex for the next 2-3 times (once was during my period), but I had it again (lighter than the other times) last Wednesday night.  

I had a normal Pap in December, but was told that I do have a Nabothian cyst.  I have had no other gyn. issues.

I visited my nurse practitioner Thursday morning and explained what was occurring.  She asked about other symptoms (none), and looked at my cervix, which she reported looked healthy-no blood or discharge, healthy color.  She also could still see the cyst but said there have been no changes with it.  I asked to have my Pap early and she declined to do it, saying that she believed I have cervicitis and that a Pap would just irritate things further.  I asked what could cause cervicitis, and she seemed to think it could have been anything.  She sent me on my way with 10 days worth of Doxycycline and scheduled a follow-up in a month.

I have several questions about this.  Could rough sex cause the cervicitis?  Should cervicitis be visible to the naked eye during the exam?  If not how is it diagnosed definitively?  Should I get a second opinion?  I am now terrified of cervical cancer, though the NP stated that that would be almost impossible due to my age, lack of further symptoms, and lack of risk factors, and normal Pap within the last year.  I have been too scared to be intimate with my husband since.  Does the watch-and-wait seem appropriate?

Thank you in advance for your help!

[Elaine Brown, MD]

Hi!
Cervicitis is simply inflammation of the cervix.  It can be caused by anything.  In your case, if you were my patient, I might suspect that the pill has caused an ectropion (you can google this term--its hard to explain) and that this is what is causing the bleeding.  Doxycycline will clear up most bacterial causes, and won't cause any harm, unless you get a yeast infection from taking it--yeast can cause bleeding too.

A pap COULD be repeated, but would very likely be normal, and not covered by insurance.  I would offer it, but probably discourage it.  I would also offer you the option of trying another alternative for birth control for awhile to see if that helped.

Whatever the case, your nurse is absolutely correct that the chance of  cervical cancer is very remote.

I hope this helps!
Dr B

[jbrokeri1982]

It seems from what I found online that an ectropion is usually seen by the naked eye.  Is this always the case?  The nurse stated that she couldn't see anything, though because this just started and is minor to this point, could it be something that is just growing/changing?

Thanks!