Vaginal bleeding after sex can be caused by dryness, tearing, an infection, or a growth in the uterus, such as cancer or polyps.
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 may warrant a visit to the doctor.
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 most likely caused by a common condition.
Vaginal dryness can lead to bleeding. In addition to the genitourinary syndrome of menopause (GSM), other factors can cause vaginal dryness, such as:
- having intercourse before being fully aroused
- friction during intercourse
- chemicals in feminine hygiene products, laundry detergents, and pools
- certain medications, including cold medication, asthma medications, some antidepressants, and anti-estrogen drugs
- having your ovaries removed
- chemotherapy and radiation therapy
- Sjögren’s syndrome, an inflammatory disease of the immune system that reduces moisture generated by glands in the body
Some infections can cause inflammation of the tissues in the vagina, which may lead to bleeding. These can include:
- pelvic inflammatory disease (PID), an infection of the reproductive organs in the lower abdomen, which includes the fallopian tubes, ovaries, cervix, and uterus
- sexually transmitted infection (STI), such as chlamydia
- cervicitis, which is inflammation of the cervix that occurs as the result of an infection
- vulvovaginitis, which is inflammation of the vulva and vagina that often occurs due to an infection
Cervical ectropion is considered benign or not harmful. It occurs when the cell type that typically grows on the inside of the cervix grows on the outside instead. Cervical ectropion may result in an inflamed area.
However, it is considered a natural variant and tends to occur in:
- pregnant people
- people using hormonal contraception
- people who menstruate
Genitourinary syndrome of menopause (GSM)
As you get older, especially when your menstrual periods stop, your body produces less estrogen.
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.
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.
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.
Irregular vaginal bleeding, including bleeding after sex, is a common symptom of cervical or vaginal cancer. In fact, according to a review of literature from 2021, up to
You may be at greater risk of postcoital bleeding if you:
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 experience any vaginal bleeding after menopause, talk with a doctor right away.
You should also consult with a 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
If you need help finding a primary care doctor or gynecologist, you can browse doctors in your area through the Healthline FindCare tool.
What happens when you see a doctor?
You can visit a primary care doctor or gynecologist for postcoital bleeding. The 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, they may also ask about your sexual history. For example, they may ask if you use condoms or barrier methods regularly.
A doctor may recommend a physical exam depending on your symptoms and history. Examining the area may help the 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, the doctor might also order tests, such as a pap smear, pregnancy test, and vaginal cultures to look for STIs.
Some people may hesitate to visit a doctor about a sexual health question if they find pelvic exams uncomfortable. However, seeing a doctor about postcoital bleeding won’t necessarily require a pelvic exam.
If you’ve been worried about postcoital bleeding, seeing a healthcare professional may help put your mind at ease.
Bleeding after sex is commonly caused by vaginal dryness, but there are other more serious causes, too.
The doctor will first rule out serious causes such as 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.
If cancer is not the cause of your bleeding, a doctor may take additional steps to determine the source:
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)
- cigarette smoking
- past human papillomavirus (HPV) infection
If you experience postcoital bleeding and have gone through menopause, see a 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.
Serious complications from postcoital bleeding aren’t common unless the cause is cancer or an untreated condition. The following include some possible complications.
Heavy or prolonged bleeding can cause iron deficiency anemia in very rare instances. It happens because the red blood cells in your body become 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, a 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 diet:
- peanut butter
- leafy vegetables like spinach
If you have vaginal dryness, you may have a greater risk of developing a urinary tract infection.
The cause of your vaginal bleeding will determine your treatment.
If your bleeding is due to vaginal dryness, vaginal moisturizers may 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.
- 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.
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, can be another option for some. Talk with a doctor about the risks and benefits of this treatment.
Vaginitis can be caused by an infection or vaginal dryness. The cause may also be unknown. Depending on the cause, a doctor may prescribe an antibiotic.
Antibiotics may also be prescribed to treat pelvic inflammatory disease and STIs.
If your cervix is inflamed because of cancer or precancer, a doctor may remove affected cells using silver nitrate or cryosurgery. In this process, damaged cells are frozen and killed.
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 a condom, 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 with a doctor about the best options to prevent future episodes.
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.
Bleeding after sex can be caused by dryness, infections, or other conditions such as cervical or uterine cancer.
If the bleeding is occasional and mild, you may not need to see a doctor.
But if the bleeding occurs often, occurs alongside other symptoms, or you have postcoital bleeding after menopause, it may be best to see a doctor. They can determine the cause and treatment.