By Medicover Hospitals / 10 Mar 2021
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 is Bleeding After Sex?
- When to visit a Doctor?
What is Bleeding 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:
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.
- 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
- 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.
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:
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.
- what contraception you are using
- any other medicine you are taking
- the last time you had a cervical smear
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.
- Vaginal atrophy or dryness: Using lubrication during sex can help. If estrogen is the problem, your doctor may recommend hormone replacement therapy in pill, insert, or cream form.
- Cervicitis: Your doctor will prescribe an antibiotic.
- Cervical ectropion: This is normal for many women (and would not require treatment), but if there are symptoms, such as excessive discharge or bleeding, it might require treatment.
- Cervical polyps: Almost all cervical polyps are benign. If your signs are minor, you may not need treatment. When removed, it is because of a low risk of abnormal cells in association with irregular bleeding. All removed polyps are sent for evaluation to ensure cells are normal.
- Uterine prolapse: For minor prolapse, your doctor may recommend weight loss or Kegel exercises to strengthen the muscles in the area. In more severe cases, your doctor may insert a ring to support the tissue or perform surgery to repair it.
- Lesions: Your doctor may do additional tests to take a closer look and determine if they are cancerous. A procedure can remove lesions with a laser or a freezing technique.
- Cervical cancer: If cervical cancer is diagnosed, your doctor will refer you to a gynecologist oncologist for further management. For precancerous cells, simple outpatient treatment can eliminate the abnormal cells. If the cells are cancerous, your doctor will likely recommend chemotherapy, radiation therapy, or surgery.
When to visit a Doctor?
Signs of postcoital hemorrhage may vary depending on the root cause. Contact your doctor if your PCB is heavy, occurs often, or lasts for a long time, or if you have other symptoms, including:
- abdominal pain, nausea, vomiting, or changes in appetite
- lower back pain
- bladder problems or tingling or burning when urinating
- intestinal problems
- unexplained weakness or fatigue
- dizziness or headache
- pain, tingling or burning during sex
- unusually pale skin
- vaginal burning, stinging, or itching
- unusual vaginal discharge
- Determining how to prevent postcoital bleeding depends on what caused you bleeding in the past.
- For most people, using water-based or silicone-based lubricants will help prevent bleeding caused by vaginal dryness and friction during sex. If you use condoms, an oil-based lubricant can damage it. Water-based lubricants are recommended.
- It can also be helpful to have sex slowly and to stop if you feel pain. Regular use of vaginal moisturizers can help keep the area moist and feel comfortable.
- If your postcoital hemorrhage symptoms are related to a medical condition, you may want to discuss the best options for preventing future episodes with your doctor.
Frequently Asked Questions:
Most of the time, light bleeding after sex is because of a normal increase in the superficial veins and capillaries in the cervix and vaginal area. Likewise, vaginal bleeding, especially in early pregnancy, could also be a sign of implantation. Bleeding can even be the result of natural changes in your cervix.
Vaginal bleeding after sex is common. Although it is often referred to as “vaginal” bleeding the mildest bleeding in younger women comes from the cervix. However, other parts of your genital and urinary systems can be involved.
If the tissue in the area is torn or traumatized, which can occur during truly enthusiastic sex, this tissue is likely to bleed, even without infection and dryness. Hence the reason why more violent sex can cause bleeding. And not just bleeding, but not badly.
Postcoital bleeding - https://bjgp.org/content/56/527/453.short
Postcoital bleeding - https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.2001.00008.x
Postcoital bleeding - https://www.hindawi.com/journals/ogi/2014/192087/
Postcoital bleeding - https://link.springer.com/article/10.1007/s00404-002-0457-6