Postcoital Bleeding: Understand Why You May Bleed After Sex

concerned woman
Tara Moore/Getty images

Chances are if you are reading this you probably had an unexpected surprise after sex.

Postcoital or literally after sex bleeding can be really disturbing not to mention a real mood killer.

This type of bleeding is not related to your menstrual cycle. The amount of bleeding after sex can range from a scant amount of spotting to a heavy bright red sheet soaking puddle.

Obviously, there are many different ways to have “sex.” When talking about postcoital bleeding we are talking about bleeding that happens after sex when vaginal penetration was involved.

So, that means postcoital bleeding can happen after vaginal penetration by a penis, a dildo, a partner’s finger, a cucumber…you get the point.

Where Is the Bleeding Coming From?

Anatomically the two parts of your body that can bleed from the friction or relative trauma of vaginal sex are your vagina and your cervix.

Your Vagina

When your vagina bleeds after sex it is most likely the result of direct trauma to the wall of your vagina. This is called a vaginal laceration and the bleeding is bright red and can be quite heavy. Typically the vagina doesn’t tear with intercourse but if the vagina is not well lubricated the friction caused by vaginal penetration can tear the wall of your vagina. You might experience inadequate vaginal lubrication if:

  • Vaginal penetration occurs before you are aroused enough to self-lubricate.
  • Your estrogen levels are low. This happens during breastfeeding and with menopause
  • Vaginal lacerations may also occur after unusually rough sex or if a foreign object is used for vaginal penetration.

Although not common, vaginal lacerations are usually the cause of postcoital bleeding that is heavy enough to bring a woman to the emergency room after sex.

As a gynecologist, I have seen many women with vaginal lacerations in the emergency room.

Because the vagina has such a rich blood supply these types of lacerations bleed a lot and usually it means some stitches or suturing are needed to stop the bleeding. Sometimes it even means a trip to the operating room.

One of my most memorable cases of a vaginal laceration after sex was a young woman who had just had sex with a new partner. She denied using a foreign object. (Yes, believe it or not, I have seen a bad vaginal laceration from the creative use of a glass bottle that accidently broke!)

She was bleeding really heavily and she had a deep laceration that extended more than halfway up her vagina. She was really upset and the guy was nowhere to be found. I had to take her to the operating room to stop the bleeding.

This amount of bleeding and type of laceration was usually only the result of direct trauma by something other than a penis. I was perplexed as to why she bled so much and could offer her no real reason or reassurance.

When I saw her for follow up she told me she had talked to the guy she had sex with that night.

It turns out that he had a metal barbell implanted under the foreskin of the shaft of his penis a technique known as genital beading or pearling. Now it made sense. Her vagina was in fact, lacerated by a foreign object!

Your Cervix

Unlike the vagina, bleeding from the cervix after sex usually isn’t heavy enough to bring you to the emergency room in the middle of the night.

Typically it is a limited amount of bright red blood. It can be so minimal that you only notice it when you are wiping yourself or changing your sheets. Even though it may be minimal it is still important to discuss any bleeding after sex with your healthcare provider.

Essentially there are four reasons why your cervix may bleed after sex.

  • Cervical ectropion – The cervix has two regions and two types of cells. The outside of the cervix has the same type of cells as the vagina but the inside or canal of the cervix has a different type of cells. The cells that cover the cervix act as a barrier and are resistant to the vaginal environment including the friction of intercourse. However, the cells that line the canal of the cervix are much more fragile.  Cervical ectropion describes a condition or an anatomical variation where the canal of the cervix is kind of turned inside out exposing these more fragile cells to the vaginal environment. Pregnancy and birth control pill use can be associated with these changes. These cells bleed very easily when touched even lightly. If you have this variation of your cervix it is very likely you will have postcoital bleeding.
  • Cervical polyps - The cells that line the canal of the cervix can also make polyps. Endocervical polyps are generally benign growths. Because they have such a rich blood supply they bleed really easily. These polyps develop in the canal of your cervix but as they grow they stick out of the end of your cervix. This puts the polyp in a perfect position to be irritated during sex.
  • Cervicitis - This is an inflammation of the cervix. Bleeding after sex can also be a sign of an infection. Chlamydial infection is the most common cause of acute cervicitis. In the early stages a chlamydial infection has no real symptoms but it is a serious sexually transmitted infection that can affect your fertility. So, it is very important to see your healthcare provider if you are having any new onset postcoital bleeding.
  • Cervical cancer - This is by far the most serious cause of postcoital bleeding. However, it is the least likely cause of your post-coital bleeding! This is especially true if you have been seeing your healthcare provider for routine cervical cancer screening. Of course, cervical cancer is the first thing you will often find on an Internet search for postcoital bleeding. So, if you are reading this take a big cleansing breath and don’t panic. There are many other causes of your postcoital bleeding and it is very, very unlikely you have cervical cancer. However, as always it is important to discuss postcoital bleeding or any other concerns you have with your healthcare provider.

See Your Healthcare Provider

If you are having postcoital bleeding, you may also be experiencing abnormal uterine bleeding that is not related to sex. About 30 percent of women who bleed during sex, also have other episodes of abnormal bleeding outside of their regular monthly period. Usually, postcoital bleeding is painless although about 15 % of women with bleeding after sex will also complain of pain with sex or dyspareunia.

It is important that you see your healthcare provider if you are experiencing postcoital bleeding. To help your healthcare provider determine the cause of your bleeding you should think about how you would answer the following questions:

  • Do you have a new sex partner?
  • When did the bleeding start?
  • Do you practice safe sex?
  • Do you use any sex toys or other foreign objects during sex?
  • Do you have pain with sex?
  • Do you always bleed after sex or only at certain times of the month or in certain positions?
  • Do you have bleeding outside of your regular period that is not related to sex?

You may feel embarrassed or awkward about discussing bleeding after sex with your doctor. But your sexual health is an important part of your overall health and it is very important for you to bring it up with your doctor even if they forget to ask. And if your doctor doesn't make the conversation easy for you, maybe you should think about finding a new gynecologist!

Shapely,M.Postcoital bleeding in women.In: UpToDate,Post TW(Ed),UpToDate,Waltham,MA (Accessed on February 24,2016)

Continue Reading