What Is Postcoital Bleeding?

Understand Why You May Bleed After Sex

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​Chances are that if you are reading this you probably had an unexpected surprise after sex. Postcoital or after sex bleeding can be alarming at first, 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 referring to bleeding that happens after sex when vaginal penetration is involved. That means postcoital bleeding can happen after vaginal penetration by a penis, a dildo, a partner’s finger…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. 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.
  • After unusually rough sex or if a foreign object is used for vaginal penetration. This includes if your partner has genital piercings or implants, such as metal barbells.

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.

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

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 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 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. Bleeding after sex can also be a sign of an infection and cervicitis is inflammation of the cervix.

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. It is very important to see your healthcare provider if you are having any new onset postcoital bleeding.

Cervical CancerThis 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 find on an internet search for postcoital bleeding. If you are reading this, take a big cleansing breath and don’t panic. There are many other causes of your postcoital bleeding and there's no need to assume it is cervical cancer right away. However, 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. Approximately 30 percent of women who bleed during sex also have other episodes of abnormal bleeding outside of their regular monthly period. 

Postcoital bleeding is typically painless. Only about 15 percent 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, 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. Your sexual health is an important part of your overall health and it is very important for you to bring it up, 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.

Source:

Casey PM, Long ME, Marnach ML. Abnormal Cervical Appearance: What to Do, When to Worry? Mayo Clinic Proceedings. 2011 Feb; 86(2): 147–151. doi:10.4065/mcp.2010.0512.

Tarney CM, Han J. Postcoital Bleeding: A Review on Etiology, Diagnosis, and Management. Obstetrics and Gynecology International.  2014;2014:192087. doi:10.1155/2014/192087.

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