Bleeding after sex is also known as postcoital bleeding. Postcoital bleeding can be alarming. This type of bleeding is unrelated to your menstrual cycle, and the amount of bleeding after sex can range from a small amount of spotting to a bright red, leaf-soaked puddle. Anatomically, the two parts of your body that may bleed from friction or the relative trauma of vaginal sex are your vagina and cervix.
What causes a woman to bleed after sex?
Bleeding after sex is a condition in which there is any type of mild to severe bleeding from the vagina after vaginal sex. Bleeding after sex, also known as bleeding after intercourse or postcoital bleeding, can result from a variety of conditions or diseases which include:
- Abnormal growths (such as polyps or fibroids) on the cervix or in the womb
- Abnormal cells in the cervix (possibly precancerous cells)
- Infection or inflammation of the vagina, uterus, or cervix
- Malignancy (cancer)
- Trauma to the vagina or cervix
Bleeding after sex is not normal. However, there are many underlying causes of bleeding after sex, such as vaginal dryness and cervical dysplasia, are very treatable if diagnosed and treated early. Treatment for bleeding after sex varies and is tailored to the individual case, the underlying cause, the severity of the signs, and the presence of any complications.
Sometimes bloody urine, due to bleeding from the urinary tract, or bloody stool, due to bleeding from the gastrointestinal tract, can be mistaken for vaginal bleeding after sex. Any unexplained bleeding should be evaluated by your physician or gynecologist.
Some types of bleeding after sex can be caused by serious or even fatal conditions, such as cervical cancer or sexually transmitted diseases (STDs). See a doctor promptly if you have any bleeding after sex, even if it is light spotting. Early diagnosis and treatment of bleeding after sex reduce the risk of serious complications, like infertility and metastatic uterine cancer.
Causes
Menstruation
This may seem obvious, but before you call your doctor, ask yourself if it's around this time of the month.
Vaginal atrophy or dryness
This is usually related to a lack of estrogen (and often appears after menopause).
Cervicitis
This is an inflammation or infection of the cervix. This can cause bleeding or a change in your vaginal discharge. Causes include:
- Sexually transmitted diseases, such as chlamydia.
- Bacterial vaginosis or an imbalance of bacteria naturally present in the vagina. Although this is not a likely cause, sometimes secondary inflammation can cause bleeding after sex.
- Trichomoniasis, or sexually transmitted infection by a parasite.
Cervical ectropion
The soft glandular cells that line the inside of the cervical canal dilate in the outer part of the cervix (where the cells are usually harder).
Cervical polyps
These are growths at the opening of the cervix that sometimes result from chronic inflammation or hormonal changes.
Uterine prolapse
If the uterus comes out of its normal position, sometimes the cervix and other tissue are exposed. If the condition is severe enough, it can cause bleeding.
Lesions
Lesions found in the cervix are often benign. But they can bleed after sex.
Cervical cancer
About 11% of women with cervical cancer experience post-coital bleeding. It is often the first symptom of cancer.
Diagnosis
To find out the cause of the bleeding, your doctor will need to ask you personal questions about your sexual activity. These questions can be embarrassing, but your doctor talks about this sort of thing all the time. The more information you give them, the easier it will be for them to find out what is going on.
Your doctor will also need to find out about:
- what contraception you are using
- any other medicine you are taking
- the last time you had a cervical smear
If you do not see your regular doctor, it may be very helpful to take your medicines such as “the pill” with you if you are using it.
Tests and Procedures
Your doctor may also ask you for some common tests and procedures, such as:
- A urine sample to check for pregnancy or a urinary tract infection.
- A vaginal exam to look for the causes of bleeding in the vagina or cervix. This examination is equivalent to a smear test.
- A smear test can be repeated and infection tests can be done at the same time.
- Sometimes your doctor may also do a test called pipelle. This is done at the same time as a smear test, but using a very thin plastic tube to take a sample of the lining of the uterus. The doctor will want to know if you are pregnant before this test.
- An ultrasound, especially if your pregnancy test is positive, the exam suggests there is a problem with your uterus or ovaries, you are over 45, or if there is a family history of certain types of cancer.
