Vaginal Bleeding During or After Sexual Intercourse

Benign and Serious Causes of Postcoital Bleeding

Hispanic woman thinking on bed
JGI/Jamie Grill/Blend Images/Getty Images

You've just finished having sex. You're in that pleasant, dream-like, post-coital state, thanks to those feel-good hormones that come with intimacy and orgasm. Then you go to the bathroom and discover you're bleeding. What's wrong? What happened? Did the skin of your vulva or vagina become irritated during intercourse? 

There are many possible causes for why you may experience bleeding from the vagina, either during or just after sexual intercourse—a phenomenon called 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.

But sometimes postcoital bleeding can be a sign of cancer. This is why it is important to see your doctor if you are experiencing bleeding as a result of sex.

Here's a rundown of common causes of bleeding associated with sex:

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). Due to the exposure of these cells to the vaginal portion of the cervix, 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

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).

Sexually transmitted Infections (STIs)

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 common STIs 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

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.

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

Endometriosis

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.

Cancer

Bleeding during or after sex can be a sign of cancer, including cervical, vaginal, or uterine cancer. To evaluate a woman for vaginal or cervical cancer, a gynecologist will perform a pelvic exam and a pap smear. A woman may need a colposcopy, depending on these results. That being said, even if the pap smear is normal, sometimes a colposcopy is still warranted, especially if the postcoital bleeding is persistent.

If uterine cancer is a concern, a sampling of the uterine tissue can be removed and looked at under a microscope.

Trauma

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

A Word from Verywell

While bleeding during or after sex may be a frightening experience for some and more of a nuisance for others, it is important regardless to see your doctor for an evaluation. The good news is that most causes of postcoital bleeding are due to something benign (non-cancerous). But it is best to be proactive and see your doctor in order to ensure nothing serious like cancer is the cause.  

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 CM, Han J. Postcoital bleeding: A review on etiology, diagnosis, and management. Obstet Gynecol Int. 2014;2014:192087.

 

Continue Reading