Vaginal Bleeding After or During Sex

It's not normal to bleed after sex, so get it checked out

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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 many causes of postcoital bleeding are benign and include conditions like inflammation or noncancerous growths in the uterus or cervix.

But sometimes post coital bleeding can be a sign of cancer or an infection that requires prompt treatment.

It's important to see your doctor if you are experiencing bleeding after sex. In other words, it's not a normal phenomenon, so it warrants investigation.

Here's a rundown of common causes of bleeding after sex. In all cases, don’t try to diagnose yourself. Be sure to seek an evaluation from a doctor.

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, as well as frequent and painful urination.

These infections can be treated with antibiotics but left untreated, chlamydia and gonorrhea may 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 result in vaginal discharge and itching. Like chlamydia and gonorrhea, a trichomonas infection is treated with an antibiotic.

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 50s. 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 noncancerous 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 raw, and it may bleed during sex or a pelvic exam, as the blood vessels from inside the cervix are fragile and friable.

Besides bleeding after sex, another potential symptom of cervical ectropion includes a clear or yellow-tinted vaginal discharge that does not have an odor.

Cervical ectropion is often found in adolescents, women taking birth control pills, and pregnant women whose cervixes are softer than normal.

It usually does not require treatment unless a woman has excessive vaginal discharge or bleeding, and this is uncommon.

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. Other clues of vaginal atrophy include vaginal dryness, burning, and itching. 

Atrophic vaginitis can also be treated with estrogen, either locally delivered to the vagina or taken systemically.

It should be known that systemic hormone replacement therapy carries some potential risks, so requires a careful discussion with a woman's physician.

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 like painful menstrual cramps or pain during sex would signal a problem well before vaginal bleeding occurred.

When Bleeding After Sex Means Cancer

While there are other more likely causes of postcoital bleeding, it is one of the warning signs of cervical, vaginal, or uterine cancer. To evaluate a woman for cervical cancer, a gynecologist or other healthcare provider will perform a pelvic exam and a pap smear, and often a colposcopy as well.

In addition to bleeding after sex, other potential signs and symptoms of cervical cancer, according to the  American Cancer Society include:

  • Bleeding after menopause or in between menstrual periods
  • Heavy or longer than usual periods
  • Vaginal discharge that is not usual and may contain some blood

If a doctor is suspicious of uterine cancer, a tissue sample either from a biopsy or a D&C is taken and examined under a microscope for cancer cells. 

Lastly, other possible signs and symptoms of uterine cancer include vaginal bleeding between periods or bleeding after menopause. Less commonly, a woman with uterine cancer may experience a non-bloody vaginal discharge, pelvic pain, or feel a growth in her pelvic area. 

A Word From Verywell

Note that this is not an exhaustive list of postcoital bleeding. For instance, bleeding after sex can also be a sign of sexual abuse or other genital trauma, including the presence of foreign bodies. The big picture here is that it's important to not ignore bleeding after sex, so get it checked out by a medical professional. 

Sources:

American Cancer Society. (2017). Diagnosis of Endometrial Cancer.

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

National Institute of Health. (n.d.). Endometriosis.

Tarney, C.M., Han, J. (2014). Postcoital Bleeding: A Review on Etiology, Diagnosis, and Management. Obstetrics and Gynecology International.

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