What Causes Bleeding After Sex?

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT on November 15, 2017Written by Susan York Morris

Overview

Many women experience vaginal bleeding after sex at one time or another. In fact, up to 63 percent of postmenopausal women experience vaginal dryness and vaginal bleeding or spotting during sex. Additionally, up to 9 percent of menstruating women experience postcoital 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 doctor.

Causes of bleeding after sex

Bleeding after sex is medically known as postcoital bleeding. It occurs in women of all ages. In younger women who haven’t reached menopause, the source of the bleeding is usually the cervix. In women who have gone through menopause, the source of the bleeding is more varied. It can be from the:

  • cervix
  • uterus
  • labia
  • urethra

In terms of causes, cervical cancer is the greatest concern. This is especially true for postmenopausal women. 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:

Genitourinary syndrome of menopause (GSM)

GSM was formerly known as vaginal atrophy. The condition is common in women in perimenopause and menopause, and those who’ve had their ovaries removed. As you get older, especially when your menstrual periods stop, your body produces less estrogen. Estrogen is the female 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 thinner and shrink. 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:

  • breastfeeding
  • childbirth
  • 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 are fully aroused
  • douching
  • 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

Learn more: Postpartum vaginal dryness »

Polyps

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 women diagnosed with cervical cancer first sought treatment. Postmenopausal bleeding can also be a symptom of uterine cancer.

Are you at greater risk of bleeding after sex?

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
  • have sex with multiple partners without using condoms
  • aren’t fully aroused before intercourse
  • douche frequently

See a doctor for these symptoms

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.

What happens when you see your doctor?

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 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 STDs.

Many women 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 your doctor does recommend a pelvic exam, talk to them about options to make it more comfortable for you. For example, case reports suggest that different leg positions and using water-based lubricants can make pelvic exams easier for some women. If you’ve been worried about postcoital bleeding, seeing your doctor 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 women over age 50 or women who’ve experienced menopause.

In addition to age, other risk factors include a family history of one of these cancers, being overweight (for endometrial cancer), or taking birth control pills for five or more years (for cervical cancer). Being infected with 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 infection. Following are some possible complications.

Anemia

Heavy or prolonged bleeding can cause iron-deficiency anemia because the red blood cells in your body are depleted through blood loss. Signs of anemia include:

  • fatigue
  • weakness
  • dizziness
  • headaches
  • unusually pale skin

If your anemia is caused by blood loss, your doctor may prescribe an iron supplement. But the most important source of iron is diet. If you are concerned about your iron levels, add more of these iron-rich foods to your diet:

iron-rich foods

Infection

If you have vaginal dryness, you are at greater risk of getting 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

Treating postcoital bleeding

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.

Vaginal lubricants also reduce uncomfortable friction during intercourse. You may want to avoid products containing parabens or propylene glycol.

Caution

  • Petroleum-based lubricants, such as Vaseline, 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

If your vaginal dryness is caused by menopause or removal of the ovaries, talk with your doctor about estrogen therapy. Topical estrogen products include vaginal estrogen creams and suppositories. 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 women. Talk with your doctor about the risks and benefits of this treatment.

Additional treatments

Vaginitis can be caused by 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 STDs.

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 women, using water- or silicone-based lubricants will help prevent bleeding caused by vaginal dryness and friction during sex. If you are 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. Take care to stick to the treatment plan recommended by your doctor.

Outlook

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.

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