Many people with vaginas experience vaginal bleeding after sex at one time or another. In fact, up to 63 percent of postmenopausal people experience vaginal dryness and vaginal bleeding or spotting during sex.
Additionally, up to 9 percent of menstruating people experience postcoital (after-sex) bleeding.
Occasional light bleeding is usually not a cause for concern. If you have certain risk factors or have gone through menopause, bleeding after intercourse warrants a visit to the doctorCauses of bleeding after sex
Bleeding after sex is medically known as postcoital bleeding. It occurs in people of all ages. In younger people who haven’t reached menopause, the source of the bleeding is usually the cervix.In those who have gone through menopause, the source of the bleeding is more varied. It can be from the:
In terms of causes, cervical cancer is the greatest concern. This is especially true for postmenopausal people. However, postcoital bleeding is more likely to be caused by a common condition.Infections
Some infections can cause inflammation of the tissues in the vagina, which may lead to bleeding. These include:
As you get older, especially when your menstrual periods stop, your body produces less estrogen. Estrogen is the hormone responsible for regulating your reproductive system.
When your estrogen levels are lower, several things happen to your vagina.
Your body produces less vaginal lubrication, so your vagina can become dry and inflamed.
Lower estrogen levels also reduce the elasticity of your vagina. Vaginal tissues become more fragile, get less blood flow, and are more susceptible to tearing and irritation. This can lead to discomfort, pain, and bleeding during sex.Vaginal dryness
Vaginal dryness can lead to bleeding. In addition to GSM, vaginal dryness can be caused by many other factors, such as:
- having your ovaries removed
- certain medications, including cold medicine, asthma medications, some antidepressants, and anti-estrogen drugs
- chemotherapy and radiation therapy
- having intercourse before you’re fully aroused
- chemicals in feminine hygiene products, laundry detergents, and pools
- Sjögren’s syndrome, an inflammatory disease of the immune system that reduces moisture generated by glands in the body
Polyps are noncancerous growths. They’re sometimes found on the cervix or in the endometrial lining of the uterus. A polyp dangles like a round pendant on a chain. Polyp movement can irritate the surrounding tissue and cause bleeding from small blood vessels.Vaginal tearing
Sex, especially vigorous sex, can cause small cuts or scrapes to the vagina. This is more likely to happen if you have vaginal dryness due to menopause, breastfeeding, or other factors.Cancer
Irregular vaginal bleeding, including bleeding after sex, is a common symptom of cervical or vaginal cancer. In fact, it was the symptom for which 11 percent of those diagnosed with cervical cancer first sought treatment.
You may be at greater risk of postcoital bleeding if you:
- have cervical or uterine cancer
- are in perimenopause, menopause, or are postmenopausal
- recently had a baby or are breastfeeding
- aren’t fully aroused before intercourse
- douche frequently
The symptoms you may experience along with postcoital bleeding vary depending on the cause. If you aren’t menopausal, have no other risk factors, and have only minor spotting or bleeding that goes away quickly, you probably don’t need to see a doctor.
If you have any vaginal bleeding after menopause, see your doctor right away.
You should also consult your doctor if you have any of the following symptoms:
- vaginal itching or burning
- stinging or burning sensation when urinating
- painful intercourse
- heavy bleeding
- severe abdominal pain
- lower back pain
- nausea or vomiting
- unusual vaginal discharge
You can visit your primary care doctor or gynecologist for postcoital bleeding. Your doctor will ask questions about your symptoms, such as how long and how heavily you’ve been bleeding. They may also ask about the color of the blood.
Because your symptoms are related to sexual activity, your doctor may also ask about your sexual history. For example, they might ask if you use condoms or barrier methods regularly or if you have more than one sexual partner.
Depending on your symptoms and sexual history, your doctor could recommend a physical exam. Examining the area may help your doctor find the source of the blood. Postcoital bleeding may come from your vaginal walls, cervix, urethra, or vulva.
To help determine what’s causing the bleeding, your doctor might also order tests, such as a pap smear, pregnancy test, and vaginal cultures to look for STIs.
Many hesitate to visit their doctor about a sexual health question if they find pelvic exams uncomfortable. However, seeing your doctor about postcoital bleeding won’t necessarily require a pelvic exam.
If you’ve been worried about postcoital bleeding, seeing your healthcare provider may help put your mind at ease.
Cervical and uterine cancer
Vaginal bleeding, including bleeding after sex, can be a symptom of cervical and uterine cancers. These cancers are most common in people over age 50 or those who’ve experienced menopause.
In addition to age, other risk factors include a family history of one of these cancers, excess weight (for endometrial cancer), or cigarette smoking. Getting the human papilloma virus (HPV) is another risk factor for cervical cancer.
If you experience postcoital bleeding and have gone through menopause, see your doctor to identify or rule out cervical and uterine cancers.
As with other types of cancer, treatment is most effective when the cancer is found and treated early.Complications
Serious complications from postcoital bleeding aren’t common, unless the cause is cancer or an untreated condition. Following are some possible complications.Anemia
Heavy or very prolonged bleeding can cause iron deficiency anemia in very rare instances because the red blood cells in your body are depleted through blood loss. However, this is not typical of postcoital bleeding.
Signs of anemia include:
- unusually pale skin
If your anemia is caused by blood loss due to postcoital bleeding or other reasons, your doctor may prescribe an iron supplement. But the most important source of iron is diet. If you’re concerned about your iron levels, add more of these iron-rich foods to your dietInfection
If you have vaginal dryness, you’re at greater risk of developing a urinary tract infection.Identifying the cause
Bleeding after sex is commonly caused by vaginal dryness, but there are other more serious causes, too. Postcoital bleeding can be a symptom of many conditions.
Your doctor will first rule out cancer by examining your vagina and cervix, taking a pap smear, and possibly conducting a biopsy. If cancer is found, you’ll be referred to a specialist.After cancer is eliminated as the cause of your bleeding, several steps may be taken to determine the source:
- examination of your vagina and cervix, either visually or through a magnifying device called a colposcope
- transvaginal ultrasound
- urine test
- blood tests
- testing of your vaginal discharge
The cause of your vaginal bleeding will determine your treatment.Lubricants
If your bleeding is caused by vaginal dryness, vaginal moisturizers can help. Applied regularly, these products are absorbed by the walls of the vagina. They increase moisture and help restore the natural acidity of the vagina. Shop for vaginal moisturizers online.
Petroleum-based lubricants, such as Vaseline (petroleum jelly), can damage latex condoms and diaphragms. Don’t mix Vaseline and condoms. Use a lubricant containing water or silicone if this is a concern.Estrogen therapy
Another option is an estrogen ring. This is a flexible ring that’s inserted in the vagina. It releases a low dose of estrogen for 90 days.
Oral hormone therapy, which replaces the hormones estrogen and progestin, is another option for some. Talk with your doctor about the risks and benefits of this treatment.Additional treatments
Vaginitis can be caused by an infection or vaginal dryness. The cause may also be unknown. Depending on the cause, your doctor may prescribe an antibiotic.
Antibiotics may also be prescribed to treat pelvic inflammatory disease and STIs.
If your cervix has been damaged by an infection, your doctor may remove affected cells using silver nitrate or cryosurgery. In this process, damaged cells are frozen and killed.Preventing bleeding after sex
Determining how to prevent postcoital bleeding depends on what has caused bleeding for you in the past.
For most people, using water- or silicone-based lubricants will help prevent bleeding caused by vaginal dryness and friction during sex. If you’re using condoms, an oil-based lubricant can damage it. Water-based lubricants are recommended.
It may also help to take sex slowly and to stop if you feel pain. Using vaginal moisturizers regularly can help keep the area moist and make you feel comfortable.
If your symptoms of postcoital bleeding are related to a medical condition, you can talk to your doctor about the best options to prevent future episodes.Bottom Line:
Bleeding after sex is usually a symptom of another condition. Many of these, such as infections and polyps, are treatable. Occasional spotting after sex generally clears up on its own without medical care. If you’re postmenopausal, promptly notify your doctor about any postcoital bleeding.References:
Written by Susan York Morris — Updated on November 6, 2020
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