What Causes Bleeding After Sex?

Vaginal bleeding after penetrative sex is relatively common and not necessarily a cause for health concern as long as there is an identified reason for it.

For example, if it’s your first time having sex, it’s normal to expect some bleeding immediately after or even a couple of days afterwards.

But if it’s not your first time and you notice bleeding, this might be a sign of something else – an underlying condition.

Vaginal bleeding after sex (also called postcoital bleeding) is not related to menstruation but may serve as a sign that you’re about to start your period. Bleeding due to menstruation after sex is not considered postcoital bleeding.

There are a number of reasons you may experience bleeding after sex, ranging from minor to severe cases.

Most are benign and can be easily treated at home or by a doctor.

Postcoital bleeding occurs in 0.7-9% of menstruating people. 

Risk Factors for Bleeding After Sex

Below are some risk factors for postcoital vaginal bleeding.

Vaginal Itching

Bleeding after sex can be associated with vaginal itching, which can be caused or increased by sexual activity.

Those who experience vaginal itching may also experience pain during sex, spotting or light vaginal bleeding, vaginal discharge, or a variety of other symptoms. 

Cancer

Bleeding after sex can, in rare cases, be a sign of cancer, such as:

• Vaginal cancer
• Cervical cancer
• Endometrial (uterine) cancer

A common symptom of endometrial cancer is abnormal vaginal bleeding, which allows it to be detected at an early stage.

The risk for cancer increases by about 10% in people who are in the postmenopause phase.

If you’re in post-menopause and experiencing postcoital bleeding, it is advisable to see a doctor right away.

Causes

Some causes of postcoital bleeding include:

Menopause 

Menopause refers to the 7 to 14-year period that occurs a year after your last period. It can be a reason for postcoital bleeding.

Often, people who are in menopause experience vaginal dryness, which can lead to postcoital bleeding. 

Those experiencing menopause symptoms have options available to make sex less painful. We encourage you to speak with a doctor. 

Pregnancy

Pregnancy complications, including ectopic pregnancy and miscarriage, may cause abnormal vaginal bleeding after sex. 

Cervical Polyps or Fibroids

Cervical polyps are growths on the cervical canal. Most of the time, they are benign.

They grow on the lower part of the uterus that connects with the vagina (cervix).

Polyps can range in size, color, and shape and are fairly common in people who have given birth to more than one child. 

Most people who have cervical polyps don’t experience symptoms, but postcoital bleeding can occur as a result of these growths.

Risk factors of developing cervical polyps include:

• People who are in their premenopausal phase
• People who have been pregnant more than once
• Sexually transmitted infections
• A previous history of cervical polyps

Uterine fibroids are benign (non-cancerous) tumors that grow inside the uterus.

Fibroids are relatively common, with 20-80% of females having them before the age of 50.

Fibroids can be discovered during a routine pelvic exam.

They can often grow without experiencing any symptoms, but the larger they are, the more likely you’ll experience symptoms such as:

• Heavy menstrual bleeding
• Pelvic pressure or pain
• Abdominal pain
• Frequent urination
• Lower back pain
• Enlargement of the lower abdomen
• Pain during sex
• Constipation
• Difficulty emptying the bladder fully
• Pregnancy complications
• Infertility (rare)

Cervical Ectropion 

Cervical ectropion refers to when the inner lining of the cervix grows on the vaginal side of the cervix.

People with cervical ectopy can be asymptomatic but may experience increased vaginal discharge and postcoital bleeding.

Endometriosis

Endometriosis, a disorder when the tissue that normally lines your uterus grows outside the uterus, is a relatively common cause of abnormal period symptoms. 

Endometriosis can cause pain during periods (dysmenorrhea), pain during sexual intercourse, excessive or abnormal vaginal bleeding, and a number of other pelvic pain symptoms. 

Endometriosis occurs in about 10 percent of females of reproductive age and is more common when someone else in your family has it.

Infection

Postcoital bleeding can be a sign of a sexually transmitted infection (STI), such as chlamydia or gonorrhea, or pelvic inflammatory disease (PID). 

Injury

Damage to the vaginal area, such as tears caused by childbirth, could result in vaginal bleeding.

If you have recently given birth or sustained vaginal trauma for any other reason, you should always obtain a gynecological evaluation and clearance before resuming any sexual activity. 

Vaginal Dryness  

Friction during sex due to low lubrication could cause vaginal bleeding. 

Using more foreplay to increase arousal prior to sexual activity and the use of water-based lubricants can prevent friction from occurring.

Cancer

The most serious cause of bleeding after sex is cervical cancer, which affects cells in the cervix and can be caused by various strains of human papillomavirus (HPV). 

A primary symptom of cervical cancer is postcoital bleeding, as well as bleeding between menstrual cycles or after menopause.

Although cervical cancer is the most serious cause of postcoital bleeding, its prevalence in people who experience bleeding after sex is between 3 and 5.5%. 

Diagnosis

Your doctor may diagnose you by doing the following:

Blood Tests

Endometrial cancer is often diagnosed once a woman has experienced symptoms, and the diagnosis is primarily through a biopsy or sampling of the endometrial tissue.

There is no particular blood test to diagnose endometrial cancer, but a complete blood count (CBC) can help check for other symptoms caused by endometrial cancer, such as low red blood cell count.

Pelvic Exam 

During a pelvic exam, the doctor will insert two fingers into the vagina to feel for anything that may cause postcoital bleeding.

They will also feel on top of your uterus and ovaries by pressing on your lower abdomen. Your doctor will also perform a speculum exam in order to visualize the tissues in your vagina and cervix.

Transvaginal Ultrasound

A transvaginal ultrasound examines all parts of the vagina, including the uterus, ovaries, cervix, Fallopian tubes, bladder, and vagina.

The procedure uses soundwaves to capture pictures of these pelvic organs to diagnose a condition and help discover the cause of bleeding. 

Biopsy

Based on your symptoms, an endometrial biopsy may be needed.

This is when a doctor takes and examines tissue from the uterine lining (endometrium) with a small catheter.

This procedure is done to ensure that cancer and other cell abnormalities aren’t present. A biopsy can help identify the cause of bleeding.

Treatment

If you’re experiencing bleeding after sex, whether minor or severe, please get evaluated immediately to ensure that it’s nothing serious.

Depending on the cause of your bleeding, your doctor may first recommend medication. If treating with medicine doesn’t work, surgery may be necessary.

Medications

• Hormonal birth control methods (pills, patches, or vaginal rings) can reduce menstrual flow and help regulate periods.
• Intrauterine devices (IUDs) can be used for birth control and to minimize or stop bleeding.
• Gonadotropin-releasing agonists reduce the release of the hormone that stimulates the ovaries (gonadotropin). They’re used to stop the menstrual flow and reduce the size of fibroids.
• Tranexamic acid can be used to stop excessive menstrual bleeding in very severe circumstances.
• Non-steroidal anti-inflammatory drugs can help control the pain and cramping associated with mild menstrual bleeding.

Surgery

• Endometrial ablation destroys the uterine lining, decreasing or stopping menstrual bleeding entirely. This procedure makes a future pregnancy much less likely to occur and may be associated with risks if you do get pregnant. 
• Dilation and curettage is a surgical procedure that removes tissue from the uterus and allows the tissue to regenerate.
• Uterine artery embolization is used to treat uterine fibroids by blocking blood vessels in the uterus.
• A hysterectomy removes the uterus. The procedure is typically only performed when other treatments have failed or if endometrial cancer needs to be treated.
• A myomectomy removes fibroids in the uterus but not the uterus itself.

When to See a Provider

Keep a record of your symptoms, including when menstruation begins and ends, flow level, and bleeding between periods and after sex.

You’ll want to bring this information to your doctor.

See a doctor if:

• You have signs and symptoms that may indicate endometriosis. 
• You’ve never had a vaginal infection. 
• You’ve had multiple sex partners or a recent new sex partner. You could have a sexually transmitted infection which could lead to postcoital bleeding.
• You’re a victim of physical or sexual abuse. Notifying your doctor of this information will help them treat you more effectively.

How K Health Can Help

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