Bleeding After or During Sex

Here are Main Causes

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There are many possible causes of bleeding from the vagina, either during or just after sexual intercourse, also referred to as postcoital bleeding.

The good news is that most causes of postcoital bleeding are benign and include conditions like inflammation, infection, or non-cancerous growths in the uterus or cervix. Obviously, if you’re menstruating, you’ll see blood after intercourse. But sometimes postcoital bleeding can be a sign of cancer, so it's important to see your doctor if you are experiencing bleeding after sex.

Here's a rundown of common causes of bleeding after sex. In all cases, don’t try to diagnose yourself; get an evaluation from a medical professional to be sure.

Sexually Transmitted Infections (STIs) and Vaginal Bleeding

STIs such as chlamydia and gonorrhea are caused by bacteria passed between partners during sexual contact. In women, these common STIs attack cervical cells and can cause not only bleeding but a variety of other symptoms, such as vaginal discharge, pelvic pain, itching, and burning. These infections can be treated with antibiotics. Left untreated, chlamydia and gonorrhea can lead to infertility.

Trichomoniasis is another type of vaginal infection. It is caused by a single-celled parasite that is usually spread through sex. In addition to causing bleeding after sex, it can also cause vaginal discharge and itching.

Benign Growths May Cause Bleeding After Sex

Benign growths on the cervix (called cervical polyps) or uterus (called uterine or endometrial polyps) can all lead to bleeding during or after sex.

Cervical polyps usually occur in women who have had multiple pregnancies and are in their 40s and 50. They look like red or violet tubelike growths that are fragile and bleed easily when touched.

Uterine polyps are small, soft lumps of endometrial tissue protruding inside the uterus. Polyps can also prompt bleeding between periods or after menopause.

Sometimes polyps disappear by themselves, but treatment can include surgery for some patients.

Other growths like vascular tumors of the genital tract (for example, a hemangioma) can also lead to bleeding, although these are rare.

Vaginal Bleeding and Cervical Ectropion

On the cervix, a benign condition called cervical ectropion can sometimes occur. In cervical ectropion, the cells that normally line the inside of the cervix protrude outwards around the opening of the cervix (called the external os). The external os can become red and inflamed, and it may bleed easily.

Cervical ectropion is often found in adolescents, women taking birth control pills, and pregnant women whose cervices are softer than normal. It may need treatment if a woman is having symptoms, but it can also disappear spontaneously.

Atrophic Vaginitis in Menopausal Women

Some menopausal women bleed after sex because diminishing estrogen levels cause the thinning of the vaginal walls, which can become irritated from intercourse. This is called atrophic vaginitis, a condition that can be alleviated by using lubricating gels during sex. It can also be treated with estrogen, either locally delivered to the vagina or taken systemically (though it should be known that hormone replacement therapy carries some potential risks).​

Endometriosis and Vaginal Bleeding

Endometriosis occurs when endometrial tissue, which normally lines the inside of the uterus, appears outside of it. Endometrial tissue can attach to the surface of organs in the abdomen, causing excruciating pain and potentially leading to infertility.

When endometrial lesions appear on the cervix or in the vagina, they can prompt bleeding during or after sex. Chances are that the other symptoms of this condition would signal a problem well before vaginal bleeding occurred.

When Bleeding After Sex Means Cancer

While there are other causes of postcoital bleeding, it is one of the warning signs of cervical, vaginal, or uterine cancer.

To evaluate a woman for vaginal or cervical cancer, a gynecologist or other health care provider will perform a pelvic exam and a pap smear, and often a colposcopy as well.

Postcoital bleeding can also be a sign of sexual abuse, or other genital trauma, including the presence of foreign bodies.

While bleeding during or after sex may be a frightening experience, it is important not to ignore it If you’re having postcoital bleeding, have it evaluated by a medical professional.

Sources:

American Cancer Society. Diagnosis of Endometrial Cancer.

American College of Obstetricians and Gynecologists.(2016) Gonorrhea, Chlamydia, and Syphilis.

National Institute of Health. Endometriosis.

Tarney, C.M., Han, J. (2014). Postcoital bleeding: A review on etiology, diagnosis, and management. Obstetrics and Gynecology International.

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