What Causes Bleeding After Sex?
What Causes Bleeding After Sex?
The sight of blood on your sheets or underwear after sex can be alarming — especially if you’re not expecting your period anytime soon.
Although it could signal a serious health problem, more likely it’s nothing sinister, says Meleen Chuang, MD, a clinical associate professor in the department of obstetrics and gynecology at the Family Health Centers at NYU Langone in New York City.
“Bleeding after sex, also known as postcoital bleeding, is relatively common and can have many different causes,” she says. “In most cases, it is not something to worry about and can be easily treated or safely managed.”
Up to 9 percent of women of reproductive age experience bleeding after sex at some point.[1]Here are some of the common and less common reasons for postcoital bleeding and how to know when it’s time to see your doctor.
Common Causes of Bleeding After SexPostcoital bleeding — or bleeding after sex unrelated to menstruation — typically happens because of conditions affecting the vagina or cervix, such as an infection, injury, or growth.[2] Most of these conditions aren’t dangerous, but they may require treatment, so it’s important to see your doctor.“I have had only one patient in almost 19 years of practice that had postcoital bleeding for which we could not find a cause. Everyone else has had something that needed fixing,” says Rebecca Perkins, MD, a professor of obstetrics and gynecology at Boston University Chobanian and Avedisian School of Medicine and an ob-gyn at Boston Medical Center. “I cannot emphasize this enough: Anyone with postcoital bleeding needs to see a healthcare provider and have a speculum exam to look and see what is going on.”
The following are some of the most common causes.
Cervical Polyps“Cervical polyps are small, benign growths on the cervix that can easily bleed during or after intercourse due to their fragile nature,” says Rakhee Patel, MD, an ob-gyn with Pinewood Family Care, a Direct Primary Care practice in New Jersey. These growths, which can also appear on the uterus, seldom develop into cancer.[3]“Your healthcare provider can see a polyp when they look with a speculum,” Perkins says. “Often, they can remove the polyp quickly and painlessly during your clinic visit.”
Other than bleeding after sex, symptoms of polyps include heavy menstrual periods, bleeding between periods, and white or yellow mucus.[4] If you’re experiencing symptoms, your doctor may recommend removing and testing polyps for abnormal cells.InfectionInflammation of the cervix, or cervicitis, is another common cause of postcoital bleeding, says Priyanka Gokhale, MD, an assistant professor in the department of obstetrics and gynecology and the physician house adviser at the University of Illinois Chicago. Vaginal inflammation can have a similar effect.
“Infections in the vagina or cervix can inflame and irritate the skin, causing it to bleed during sex,” Dr. Perkins says. “This can be from sexually transmitted infections like gonorrhea, chlamydia, or trichomoniasis — or from infections that are not sexually transmitted, like a yeast infection. Your healthcare provider will usually test for infections if you have bleeding after sex.”
Some infections, including herpes, can also cause sores that bleed when touched. Although these usually develop on the vulva, they can occur inside the vagina or cervix.[5]Depending on the infection type, your doctor may recommend antibiotics or an antifungal medication to clear it.[3] Although many infections are curable, most are contagious and don’t go away on their own, so it’s important to receive a diagnosis and treatment.[6]Besides bleeding after sex, symptoms of infection can include dyspareunia (painful sex), painful urination, unusual discharge, itching, burning, abdominal pain, a strong odor, warts, sores, and fever.[7]Vaginal DrynessMinor injury or tears to the vaginal, cervical, or vulvar tissue can cause bleeding after sex as well, Dr. Gokhale says. “This can commonly happen if there’s vaginal dryness or atrophy or not enough lubrication,” she says.
Vaginal dryness and atrophy can happen at any age, but commonly occur after menopause because of low estrogen, Gokhale says. Because estrogen also drops during breastfeeding, new moms often experience vaginal bleeding and dryness, too.[8] “If you have very low estrogen levels, then the skin of the vagina may be thin and sometimes tear slightly with sex. This is usually painful,” Perkins says.Postcoital bleeding can also be a side effect of combined hormonal birth control pills, which suppress the body’s natural estrogen production, leading to vaginal dryness, Gokhale says.[9]Using lubrication during sex often helps, but your doctor may recommend switching contraceptives or using an estrogen-based medication if low hormones are to blame.[3]Cervical Ectropion“Cervical ectropion is when some of the fragile gland cells that usually are on the inside of the cervix migrate to the outside of the cervix,” Perkins says. “This is normal due to hormone fluctuations — and can sometimes happen in people who are pregnant or who are taking birth control pills.”
Patel explains that ectropion can cause bleeding because the cervical cells are delicate and prone to irritation. It’s common and happens to about 17 to 50 percent of people with cervixes.[10]Your healthcare provider can diagnose ectropion by doing an exam. It usually doesn’t require treatment, but if your cervical bleeding persists, your doctor may recommend medication or a procedure to eliminate the irregular cells.[10]Less-Common Causes of Bleeding After SexThese causes of bleeding after sex are less common. Remember, it’s important to see your healthcare provider to identify what’s going on if you’re experiencing bleeding after sex.
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Pregnancy“Pregnancy can make the cervix a lot more sensitive and more likely to bleed,” Gokhale says. “More blood vessels develop in the cervix throughout the pregnancy.”
Light cervical bleeding, including after sex, is relatively common during the first half of pregnancy, according to the American Pregnancy Association (APA).[11]While it doesn’t usually indicate anything serious, Dr. Chuang says it’s important to tell your doctor.
“Bleeding with sex could be a sign of an underlying condition such as subchorionic hematoma in early pregnancy, and it may be a good idea to see your ob-gyn sooner rather than later,” she says.
Subchorionic hematomas are bleeding or clots that develop between the uterine wall and the outermost layer of the amniotic sac (chorionic membrane).[12] They usually go away on their own without causing any problems, but can sometimes lead to complications.Uterine Fibroids“Uterine fibroids are muscular growths in the uterus that can cause bleeding after sex, especially if they are located near the cervix or if it affects the lining of the endometrium,” Chuang says.[13]Fibroids are benign and usually asymptomatic.[14] But they sometimes cause pain and abnormal uterine bleeding because they can develop their own blood supply and interfere with surrounding tissues, Chuang says.“Fibroids that grow in the lining (submucous fibroids) have blood flow and can disrupt the endometrial lining after sex,” she explains. “It could be from sex stimulating the muscles of the vagina, cervix, or uterus repetitively causing contraction and postcoital bleeding.”
While some fibroids are minuscule, others grow to the size of an orange or watermelon.[15] Chuang says larger fibroids may cause symptoms such as an enlarged abdomen, difficulty urinating or defecating, or heavy uterine bleeding. If you experience such symptoms, see your ob-gyn for a pelvic sonogram.Cervical CancerThe most serious causes of bleeding after sex are cervical cancer and precancer — and they are also among the least prevalent, says Maris Toland, MD, an ob-gyn at Dartmouth Hitchcock Clinics in Bedford, New Hampshire.
“Cervical cancer is not very common in the United States, but about 11 percent of patients with cervical cancer have bleeding after sex as the first symptom they notice,” she says.[3] But again, that doesn’t mean bleeding after sex should cause alarm. Research suggests that only about 1 in 44,000 patients between ages 20 and 24 who experience bleeding after sex have cervical cancer.[16]Precancerous and cancerous cells can make the cervix more easily irritated and prone to bleeding when touched, Gokhale explains.[17]Human papillomavirus (HPV) causes most cervical cancers and precancers, Dr. Toland says.[18] Although HPV infection is very common, most of the more dangerous cancers it causes can be prevented with vaccination. Furthermore, cervical cancer is highly treatable if caught early.[19]“This is why it is important to see a healthcare professional to undergo cervical cancer screening on the recommended schedule,” she says. “If those mutated cells are caught early, they can be removed before they turn into cancer.”
When to See a DoctorIf your post-sex spotting is a one-time occurrence, Chuang says you don’t necessarily need to call your doctor. But if you’re bleeding heavily, repeatedly, or persistently — or have other unusual symptoms, such as dyspareunia (painful sex), unusual discharge, or a fever — book an appointment. Ditto if it’s been a while since your last sexual health checkup, Toland says.
The CDC recommends all sexually active women under age 25 and women older than 25 who have a new partner, multiple partners, or a partner with an STI get screened at least once a year.[20] Some providers recommend getting tested anytime you’re considering having sex with a new partner.[21]Most reasons that someone might have bleeding after sex shouldn’t cause alarm, Toland says. But, if someone is experiencing bleeding after sex, it’s a good idea to see your doctor to get it checked out.
“Testing for an infection or precancerous cells is fairly simple with a pelvic exam and a couple of swabs. Both of these are best discovered early because they can be treated,” she says.
Important note: Gokhale says that if you’re soaking through a pad an hour and experiencing severe pain, go to the emergency room, rather than wait to see your regular healthcare provider. This could be a sign of a more serious issue that needs more urgent attention.
The TakeawayIntercourse bleeding can have various causes, from a lack of lubrication to cervical cancer. Most of the time, it’s nothing serious. But if you experience postcoital bleeding more than once or have other concerning symptoms, such as dyspareunia (painful sex) or a fever, it’s essential to talk with a sexual health professional.