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Bleeding During Sex - Causes, Diagnosis and Treatment

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Bleeding during or after sex can be scary, particularly when you are not menstruating. Here are some ways to handle the scenario.

Medically reviewed by

Dr. Nikitha Murthy

Published At March 31, 2022
Reviewed AtAugust 16, 2022

Introduction:

Bleeding during or after sex is not an alarming sign of any serious underlying medical illness. Around 9 % of menstruating women may experience bleeding that is nothing related to their menstruation. And about 46 % to 63 % of postmenopausal women can experience itching, dryness, and bleeding during and after sex due to certain hormonal changes. Bleeding after sex is referred to as postcoital bleeding. It can be seen in women of all ages.

What Are the Common Causes for Bleeding During Sex?

Bleeding during sex is actually more common than you might think. The possible causes for vaginal bleeding during sex include:

1) Sexually Transmitted Infections (STIs):

Sexually transmitted infections (STIs) such as chlamydia, gonorrhea are strongly associated with symptoms like pelvic pain, itching, dryness, vaginal discharge. Every infection has its own symptoms and can cause bleeding. Syphilis and genital herpes can cause open sores, which can bleed when irritated. These pores usually develop externally, but at times they can be developed inside the vagina and can remain unnoticed until they bleed.

2) Contraception:

If an individual starts using or changes the type of contraception, bleeding can be seen during sex.

3) Pregnancy:

Around 15 % to 25 % of pregnant women experience bleeding or spotting during or after sex. This is because, during early pregnancy, more blood vessels are developed in the cervix, and so they get easily damaged by friction, causing bleeding during sex.

4) Benign Polyps:

The abnormal benign growths on the cervix or the uterus are common causes of bleeding during sex.

  • Cervical Polyps - The benign growths on the cervix are known as cervical polyps. It develops in females in their 40s and 50s who have had multiple pregnancies. Cervical polyps are red or violet-colored tube-like growths that are rich in capillaries. Hence it bleeds very easily when touched.

  • Uterine Polyps - The uterine polyps are small and soft lumps of tissue protruding from within the uterus through the cervix. They develop in females who are between 36 to 55 years of age. These uterine polyps usually bleed between periods, during sex, or after menopause.

These polyps sometimes resolve by themselves, but sometimes surgical removal is required in a few cases.

NOTE: Most of these polyps are usually benign, but sometimes they can turn cancerous over time.

5) Cervical Ectropion:

Cervical ectropion is a benign condition in which the cells that line the inside of the cervix protrude outside through the opening of the cervix. The blood vessels in the cervix are already fragile, and in this condition, these blood vessels can become dilated and inflamed, making them prone to bleeding during intercourse. This condition is commonly reported in females taking birth control pills and in pregnant women whose cervix is softer than normal.

6) Atrophic Vaginitis:

Atrophic vaginitis refers to a condition that is commonly seen in postmenopausal women. This occurs due to decreasing estrogen levels causing the vaginal walls to thin out and produce less lubricating mucus. It is also associated with vaginal itching and burning sensation.

7) Endometriosis:

Endometriosis is a condition that occurs when the lining of the uterus grows outside of the uterus. The primary symptoms of cervical endometriosis include painful intercourse, painful orgasm, and postcoital bleeding.

8) Trauma:

Bleeding during sex is often associated with infections and abnormalities in the uterus, cervix, or vagina due to any injuries to these tissues during vigorous sex, resulting in cuts or tears on the vagina. These injuries commonly occur during menopause or from excessive douching.

Even forceful penetration can severely damage the vaginal tissues causing fissures resulting in bleeding.

9) Cancer:

Bleeding during sex is one of the symptoms of cervical, vaginal or uterine cancer. The other associated symptoms of cancer include,

  • Vaginal discharge with blood.

  • Heavy or longer periods than usual.

BDS

Is Bleeding During Sex Normal?

Bleeding during or after penetration for the first time is completely normal. This happens because penetrative sex can break the hymen, the piece of skin that partially covers the opening of the vagina.

Is Bleeding After Sex During Pregnancy a Major Concern?

Light bleeding or spotting during the first twelve weeks of pregnancy is common. The reason for it is that after conception, the egg gets implanted into the blood-rich uterine lining, so light bleeding or spotting after a few days of sex may not be a reason for concern. But the most number of miscarriages occur during the first trimester so being careful is also very important.

After 12 weeks, miscarriages are less likely to occur, and bleeding occurs as the cervix and uterus have an increased amount of blood supply to it. So the blood vessels are prone to get damaged during intercourse.

If you do not experience cramps and only have bleeding after sex (during pregnancy), then you do not have to worry, but if you have any concerns, then contacting your doctor will be a wise decision.

When to Seek Medical Attention?

You have to seek an immediate medical call if you experience the following:

  • If the postcoital bleeding is severe, frequent, and continues for more than a few hours after sexual intercourse.

  • If you experience symptoms along with bleeding like:

- Severe abdominal pain.

- Burning sensation while urinating.

- Lower back pain.

- Headaches.

- Unexplained weakness.

- Nausea and vomiting.

How Is Postcoidal Bleeding Diagnosed?

When you report to the doctor about bleeding during or after sex, the doctor will rule out the cause of your bleeding. First, cancer will be ruled out by examining the cervix and the vagina. Even a Pap smear and biopsy will be conducted to determine if cancer is causing the bleeding.

And if cancer is not the underlying cause, then other causes will be determined with the help of the following diagnostic tests:

  • Transvaginal ultrasound.

  • Urine test.

  • Blood tests.

Can Postcoidal Bleeding Be Treated?

The cause of the bleeding will determine the treatment. When there is no apparent cause or if bleeding is caused due to vaginal dryness, then lubricants can help resolve the condition. These vaginal lubricants reduce friction during intercourse.

If bleeding is reported after menopause, then topical estrogen products like vaginal estrogen creams or suppositories may be recommended.

And if bleeding is caused due to infection, then antibiotics may be prescribed. You can prevent postcoital bleeding by addressing the cause and treating it.

Conclusion:

Bleeding during or after sex is a common condition, particularly in women who are no longer menstruating or who have an ovarian condition. Typically light bleeding is not an area of concern, but if you have certain associated symptoms along with the bleeding, then you may warrant a visit to your healthcare professional for guidance.

Frequently Asked Questions

1.

What Can I Do to Stop My Vaginal Bleeding?

Vaginal bleeding may or may not be due to menstruation. It requires immediate treatment if it is severe and prolonged. It includes:
- Tranexamic acid is suggested to control heavy vaginal bleeding.
- Non-steroidal anti-inflammatory drugs like Naproxen sodium, Ibuprofen, etc., are also known to decrease pain and bleeding.
- Oral contraceptives regulate regular periods and control excessive bleeding.
- An intrauterine hormonal device decreases the menstrual blood flow by producing Levonorgestrel.
- Gonadotropin-releasing agonists are also provided to reduce vaginal bleeding.

2.

Why Do I Have Vaginal Bleeding While Pooping?

The muscle contraction during pooping also exerts pressure on the vagina to release the blood left inside. Sometimes, the mild vaginal bleeding while pooping does not require medical attention. However, in a few conditions like endometriosis, where the uterus lining starts growing apart from its usual site, it causes pain and bleeding. Therefore, it is essential to visit the gynecologist to diagnose and treat such conditions.

3.

Why Do I Bleed and Have a Stomach Ache After Sex?

The stomach pain and bleeding after sex can happen due to the following:
- Vaginal dryness.
- A cyst (fluid-filled sacs) in the ovary or pelvis increases pain during sex.
- Sexually transmitted disease or any vaginal infection also causes abdominal pain after sex.
- Uterine fibroids are abnormal growth in the uterus, which usually do not cause symptoms. If it is large or more in number, it may cause pain and bleeding.
- Endometriosis is an abnormal growth of the uterus lining, outside the uterus.
- Pelvic inflammatory disease is the infection of the reproductive organs. It causes abdominal pain and bleeding during and after intercourse.

4.

When Does Implantation Bleeding Occur After Sex?

The attachment of fertilized egg to the uterus lining is referred to as implantation. It leads to a light spotting called implantation bleeding. It is not the same as menstrual bleeding and occurs 10 to 14 days after conception. The implantation bleeding is usually expected at the time of menstruation. However, it can also happen in the first twelve weeks of pregnancy. It usually resolves and does not require any treatment. The bleeding looks pinkish with no clots (seen in periods), and mild cramping is observed.

5.

What Is the Reason for My Bleeding During Sex?

The vaginal bleeding during sex occurs due to the following reasons:
- Pregnancy: The development of new blood vessels happens during early pregnancy. The friction created during sex damages it and causes bleeding.
- Sexually transmitted disease (STI) like gonorrhea and genital herpes causes dryness, pelvic pain, and vaginal discharge.
- Abnormal growth in the uterus or cervix also causes vaginal bleeding during sex.
- Endometriosis: The growth of the uterus lining outside the uterus gives rise to pain and bleeding during intercourse.
- Trauma: Any damage to tissues of the vagina or cervix also leads to bleeding.
- Cancer: Vaginal bleeding is considered a sign of vaginal or cervical cancer.

6.

How Much Bleeding Is Considered Normal After Sex?

The bleeding that occurs after the first intercourse is usually considered normal. If minor spotting happens after intercourse, it can be due to pregnancy or menstruation. But, the bleeding that is severe, frequent, and prolonged for hours is due to underlying conditions like vaginal dryness, abnormal growth in the cervix or uterus, lesions, abnormal uterus positioning, or cancer. Irregular and severe bleeding is considered abnormal, and it requires a consultation with a gynecologist for further management.

7.

Can Deep Sex Cause Bleeding?

Forceful penetration of the penis into the vagina and abnormal positioning during intercourse leads to bleeding after sex. It also occurs due to poor lubrication during intercourse. The conditions that cause bleeding after deep sex are listed down:
- Uterine polyps (abnormal growth).
- Sexually transmitted disease (STI).
- Endometriosis (abnormal development of uterus lining).
- Vaginal infection.
- Trauma.
- Vaginal, cervical, or uterine cancer.

8.

What Causes Bleeding After Sex and After Menstruation?

The factors that cause prolonged bleeding after sex and menstruation in women are:
- Vaginal infection due to pelvic inflammatory disease and sexually transmitted disease.
- Increased hormone levels.
- The use of oral contraceptives that contain high progesterone levels leads to abnormal bleeding.
- Ovulatory dysfunction (a condition that causes an ovaries' lack of egg production).
- Injury or trauma to vaginal tissues.

9.

Do I Have to Worry About Bleeding After Sex Without Any Pain?

Mild to severe bleeding after intercourse can occur due to various factors. However, there is nothing to worry about if the pain does not accompany the bleeding. It usually arises due to implantation bleeding (pregnancy). The symptoms that occur with bleeding which need immediate medical attention are severe abdominal and lower back pain, headache, nausea, vomiting, and a burning sensation while urinating.

10.

Does Bleeding After Unprotected Sex Mean I Am Pregnant?

The vaginal bleeding after sex is called postcoital bleeding. It can be due to friction. Other than that bleeding days after sex usually happens due to pregnancy. The bleeding is mild, like spotting or pinkish; it can be due to the implantation of the fertilized egg in the uterus. Other factors that cause bleeding after unprotected sex are sexually transmitted diseases, vaginal infection, etc.
Dr. Nikitha Murthy
Dr. Nikitha Murthy

Obstetrics and Gynecology

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endometriosispregnancy
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