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.
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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.
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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,
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Vaginal discharge with blood.
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Heavy or longer periods than usual.
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:
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If the postcoital bleeding is severe, frequent, and continues for more than a few hours after sexual intercourse.
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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:
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Transvaginal ultrasound.
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Urine test.
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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.
