Vaginal bleeding or spotting that occurs after intercourse is known as postcoital bleeding. Bleeding after sex can happen as a result of menstruation, vaginal dryness, inflammation, infection or cervical problems. Most of the time, it’s nothing serious. But bleeding after sex can sometimes signal larger issues, especially if it’s happening consistently.

What are the causes for bleeding after sex?

Vaginal bleeding might occur if your hymen breaks, from either vaginal intercourse or other means. When this happens, this is normal, but it’s different from postcoital bleeding. Postcoital bleeding is related to a number of conditions that are infectious or noninfectious.

“With infectious causes, we’re always concerned about genital tract infections,” says Dr. Brzozowski. “For noninfectious causes, doctors are concerned about vaginal atrophy, cervicitis and other cervical conditions.”

Here are seven common causes of postcoital bleeding:

Infections

Infections such as sexually transmitted infections (STIs) or yeast infections can lead to inflammation and irritation of the vaginal tissues, resulting in bleeding after intercourse.

Menstruation

This may seem obvious, but before you call your doctor, consider whether it’s around that time of the month. “If you have sex right before or after your period, that may explain your bleeding,” says Dr. Brzozowski. Keeping track of your cycles with a menstrual calendar is helpful for resolving such questions and understanding more about what’s happening during your menstrual cycle.

Vaginal atrophy or dryness

Also commonly referred to as vaginal dryness, vaginal atrophy is a condition where the lining of your vagina gets drier and thinner, typically because of a lack of estrogen. People of all ages can experience vaginal atrophy, though it most often shows up after menopause. “If dryness is severe, the friction of intercourse may cause bleeding,” Dr. Brzozowski explains. “Using lubrication during sex may help, but if estrogen is the issue, your doctor may recommend hormone replacement therapy in pill, insert or cream form to replace what was previously lost.”

Cervicitis

Cervicitis is the inflammation of the cervix, often as the result of infections or irritation. This condition may cause bleeding or a change in vaginal discharge. Possible causes include:

• Sexually transmitted diseases, such as chlamydia, gonorrhea or trichomoniasis.
• Bacterial vaginosis, or an imbalance of the naturally occurring bacteria in the vagina. While this isn’t a likely cause, sometimes, secondary inflammation can cause bleeding after sex.
• Chemical irritation from spermicides, douches or latex in condoms.

Although the bacterial and viral infections that cause cervicitis are contagious, this condition can be treated with antibiotics or antifungals.

Cervical ectropion

With cervical ectropion, the soft, glandular cells that line the inside of your cervical canal expand into the outer part of your cervix (where the cells are typically harder), almost as if it’s turning itself inside out. This is a normal condition for many people with a cervix and usually doesn’t require treatment. But if there are symptoms, such as excessive discharge or bleeding, it could require outpatient heat or cold therapy to treat the area and stop the bleeding.

“If you have bleeding or pain from cervical ectropion that interferes with your sex life, your doctor may recommend treatment,” says Dr. Brzozowski.

Cervical polyps

These are growths on the opening of your cervix that sometimes result from chronic inflammation or hormonal changes. Almost all cervical polyps are benign. If your symptoms are minor, you may not need treatment. Sometimes, with irregular bleeding, there’s a small chance of abnormal cells developing. In these cases, your polyps are removed and sent for evaluation to make sure those cells are benign.

Uterine prolapse

If your uterus comes out of its normal position, your cervix and other tissues are sometimes exposed. Symptoms of this condition include pelvic pain, abdominal pain or lower back pain and pain during sex. If your uterine prolapse is severe enough, it may cause bleeding.

For a minor prolapse, your doctor may recommend weight loss or Kegel exercises to strengthen muscles in the area. In more severe cases, your doctor can insert a ring to support the tissue or perform surgery to repair it.

Cervical cancer

About 11% of people who have cervical cancer have postcoital bleeding, according to Dr. Brzozowski. In fact, it’s often the first symptom of cancer and one of the things you’re probably most worried about.

“Cervical cancers are preventable in most cases as long as you follow up with your gynecologist and have a routine screening done.

Menopause

Changes in hormone levels during menopause can cause thinning and drying of the vaginal tissues, making them more susceptible to tearing during intercourse.

Trauma or Injury

Aggressive or rough sexual activity, as well as certain sexual practices, can cause trauma to the vaginal tissues, resulting in bleeding.

If you’re diagnosed with cervical cancer, your doctor will refer you to a gynecologic oncologist for further management. A simple outpatient treatment can remove abnormal precancerous cells. If the cells are cancerous, your gynecologic oncologist will likely recommend chemotherapy, radiation, surgery or a combination of treatments depending on your condition.

Is bleeding after sex normal?

A good rule of thumb is that any abnormal bleeding, whether it’s just a few drops or a large amount, needs to be evaluated.

“If you are experiencing something that isn’t normal, it’s not necessarily bad, but if it is consistently happening or you are just concerned, get it checked out.” 

During your visit, your doctor go over your medical history and ask you about:

• Other irregular bleeding.
• Heavy or irregular periods.
• Unusual pain that doesn’t seem to relate to the bleeding.
• A change in sexual partners.
• A change in vaginal discharge.
• When you had your last Pap test.

A physical exam will check for signs of infection. If your Pap test isn’t current, your doctor can perform one for you while you’re in their office. A Pap screening can help determine the need for any further tests or procedures.

If your testing shows no problems, but your bleeding continues — and it only occurs after sex — your doctor will likely want to check your cervix and do a biopsy. This may show any underlying condition that a physical exam and Pap smear didn’t find.

What are Signs and Symptoms of Vaginal Bleeding After Sex?

The appearance and characteristics of vaginal bleeding after sex can vary depending on the underlying cause. It may range from light spotting to heavy bleeding and can be accompanied by pain or discomfort during intercourse.

When to Seek Medical Help for Vaginal Bleeding After Sex? 

The symptoms you may experience along with postcoital bleeding vary depending on the cause. If you aren’t menopausal, have no other risk factors, and have only minor spotting or bleeding that goes away quickly, you probably don’t need to see a doctor.

If you experience any vaginal bleeding after menopause, talk with a doctor right away.

You should also consult with a doctor if you have any of the following symptoms:

• vaginal itching or burning
• stinging or burning sensation when urinating
• painful intercourse
• heavy bleeding
• severe abdominal pain
• lower back pain
• nausea or vomiting
• unusual vaginal discharge

While occasional vaginal bleeding after sex may not be a cause for concern, it is important to seek medical attention if:

• The bleeding is persistent or recurrent.
• There is an unusual or foul odor associated with the bleeding.
• There is pain or discomfort during intercourse.

What are Diagnosis for Vaginal Bleeding After Sex? 

Diagnosis of the underlying cause of vaginal bleeding after sex typically involves:

• Taking a detailed medical history to assess risk factors.
• Conducting a physical examination, including a pelvic exam.
• Performing laboratory tests to check for infections or hormonal imbalances.
• Using imaging tests such as ultrasound to evaluate the pelvic organs.

What are the Treatment Options for Vaginal Bleeding After Sex? 

Treatment for vaginal bleeding after sex depends on the underlying cause and may include:

• Antibiotics to treat infections.
• Hormonal therapy to manage hormonal imbalances.
• Surgical removal of polyps or other abnormal growths.
• Using lubricants or moisturizers to alleviate vaginal dryness.

What are Prevention Tips for Vaginal Bleeding After Sex? 

Taking proactive steps to prevent vaginal bleeding after sex can include:

• Practicing safe sex by using condoms and discussing sexual history with partners.
• Undergoing regular gynecological exams to detect and treat any underlying conditions early.

Impact on Sexual Health

Experiencing vaginal bleeding after sex can have psychological implications, affecting self-esteem, intimacy, and overall sexual satisfaction. Open communication with partners and seeking support from healthcare professionals can help address these concerns.

You may be at greater risk of postcoital bleeding if you:

• have cervical or uterine cancer
• are in perimenopause, menopause, or are postmenopausal
• recently had a baby or are breastfeeding
• aren’t fully aroused before intercourse
• douche frequently

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Is vaginal bleeding after sex always a sign of a serious condition?

While occasional bleeding may not be concerning, persistent or recurrent bleeding should be evaluated by a healthcare provider to rule out underlying health issues.

Can menopause cause vaginal bleeding after sex?

Yes, changes in hormone levels during menopause can lead to thinning and drying of the vaginal tissues, increasing the risk of bleeding during intercourse.

How can vaginal dryness be managed to prevent bleeding after sex?

Using lubricants or moisturizers during intercourse can help alleviate vaginal dryness and reduce the risk of bleeding.

Is it normal to experience pain along with vaginal bleeding after sex?

Pain or discomfort during intercourse, along with bleeding, may indicate an underlying issue such as infection, trauma, or hormonal imbalance, and should be evaluated by a healthcare provider.