Bleeding after sex, known as postcoital bleeding, may be a sign of a minor issue such as vaginal dryness or a more serious condition. Postcoital bleeding occurs after sex that involves vaginal penetration. It is unrelated to your menstrual cycle as the blood originates from the lining of the vagina or cervix. Depending on the cause, you might experience scant or heavy bleeding. The blood may be bright red or darker in colour.
There are many reasons why a woman may bleed after sex. Health conditions that can cause postcoital bleeding include an infection, vaginal dryness (atrophic vaginitis), damage to the vagina, such as tears caused by childbirth, or cervical or endometrial polyps. Rarely, it can be a sign of cervical or vaginal cancer.
What Causes Postcoital Bleeding?
If you experience bleeding after sex, you should discuss it with your healthcare provider who can conduct an accurate assessment. There are several health conditions that can cause postcoital bleeding. These include:
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is caused by an infection developing in the female reproductive system. It is mostly caused by untreated chlamydia or gonorrhoea which spreads from the vagina or cervix (entrance to the womb) into the uterus (womb), fallopian tubes and ovaries. Untreated pelvic inflammatory disease can cause scar tissue and abscesses (pockets of infected fluid) to form in the reproductive tract. These can cause permanent damage to the reproductive organs.
The Symptoms of PID Include:
- Unusual bleeding from the vagina, especially during or after sex, or between periods
- Pain during sex
- Fever, sometimes with chills
- Painful, frequent or difficult urination
- Foul smelling vaginal discharge
Sexually Transmitted Infections (STIs)
Chlamydia is the sexually transmitted infection (STI) most often associated with bleeding after sex. Other STIs such as gonorrhoea and trichomoniasis are also sometimes associated with postcoital bleeding.
Gonorrhoea and chlamydia are both very common bacterial sexually transmitted infections (STIs). They can easily pass from one person to another through unprotected vaginal, oral, or anal sex. They can be easily treated with a course of antibiotics. Trichomoniasis is caused by a tiny parasite that can be spread between sexual partners. Symptoms include itching, burning, painful genitalia and a foul-smelling discharge that may contain blood. Trichomoniasis is treated with antibiotics.
Vaginal dryness, also known as atrophic vaginitis or vaginal atrophy, is caused by reduced vaginal secretions. Vaginal atrophy usually occurs after menopause when the ovaries can no longer produce oestrogen. Oestrogen is the female hormone responsible for healthy skin, bone structure and a natural balance of vaginal fluids. When oestrogen levels drop vaginal tissues become thinner, drier, and less elastic. This can lead to vaginal dryness, itching, burning, pain during sex and bleeding after sex.
Damage To The Vagina
Postcoital bleeding results due to direct trauma to the wall of your vagina. Vaginal laceration (tears) can be caused by childbirth, vaginal dryness or friction during sex.
The vagina does not usually tear due to sexual intercourse, but it can happen if the vagina is insufficiently lubricated before sex. This problem is mostly seen in postmenopausal women who struggle with vaginal dryness due to depleted oestrogen levels. This condition can make tearing during intercourse more likely.
The vagina or cervix can also be damaged by unusually rough sex or if a foreign object was used for vaginal penetration.
Cervical or endometrial polyps are benign (non-cancerous) growths in the uterus or the lining of the cervix. As polyps grow, they protrude out of the end of your cervix, where they can be irritated and bleed during sexual intercourse.
Cervical ectropion, also known as cervical erosion, refers to an inflamed area on the surface of the cervix. Cervical ectropion occurs when cells that line the inside of your cervix grow on the outside. These cells are more sensitive than the cells typically on the outside, which is why they may cause symptoms such as bleeding after sex.
Although rare, the most serious cause of postcoital bleeding is cervical cancer. Human papillomavirus (HPV), a sexually transmitted infection, causes most cases of cervical cancer.
Tests And Examinations
Depending on any other symptoms and your medical history, a GP may recommend some tests or examinations, such as:
- A pregnancy test
- A pelvic examination
- Examining the cervix with an instrument called a speculum
- If the problem is caused by vaginal dryness, your GP may recommend that you try using lubricating gels or start HRT or topical oestrogen therapy.
- Cervical screening tests - HPV testing is part of cervical screening. Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer.
Treating Postcoital Bleeding
Treatment options for postcoital bleeding depend on the cause of the problem. If the condition has been caused by a sexually transmitted infection it can be treated with antibiotics.
Women suffering with vaginal atrophy may benefit from using vaginal moisturisers, probiotic pessaries or topical oestrogen treatments.
In cases where postcoital bleeding has been caused by a vaginal tear (laceration), stitches may be required. A vaginal tear that does not need stitches usually heals within two weeks. A tear that does need stitches should heal in about six weeks.