It's generally known that women can bleed after having sex for the first time, but up to 9% of menstruating women experience post-sex bleeding for various reasons long after their first experience with intercourse. Spotting after sex is technically known as "postcoital bleeding," and although a designated medical term and the bleeding itself may seem alarming, there are a number of reasons you may be experiencing spotting after sex.
To learn more, we talked to three doctors to get their expert insight on bleeding after sex. "First thing, don't panic,” says Neeraj Kohli, MD, a urogynecologist and the medical director of BostonUrogyn, adding that you should refrain from any further sexual activity until you get a better understanding of what’s causing the bleeding. Below, take a look at a list of reasons you might be spotting after sex to ease your mind or give you the needed push to call your doctor for a consult.
Meet the Expert
- Neeraj Kohli, MD, is a urogynecologist and the medical director of BostonUrogyn.
- Sara Twogood, MD, is a board certified OB/GYN in Los Angeles and the co-founder of Female Health Education and the online magazine Female Health Collective.
- Mary Jane Minkin, MD, is a Clinical Professor of OB/GYN at Yale University School of Medicine and a North American Menopause Society Certified Menopause Clinician.
What Can Cause Bleeding After Sex?
- Vaginal Atrophy: Also known as genitourinary syndrome of menopause, or GSM, vaginal atrophy is common in women who are going through or are close to going through menopause or have removed their ovaries. When a woman enters menopause, her body produces less estrogen, and when your estrogen levels are lower, your body produces less lubrication during sex. Your vaginal tissues can also shrink and become thinner. When you are experiencing vaginal atrophy, sex can cause your vagina to become inflamed and dry, which leads to pain, discomfort, and, you guessed it, bleeding.
- Cervical Ectropion: Although it might sound scary, cervical ectropion is not a disease, nor does it affect fertility or prove to be cancerous. Cervical ectropion, in simple terms, is when the soft cells of your cervical canal spread to the outside of the cervix, where the hard cells are usually located. The reason for bleeding after intercourse is the softer cells, known as glandular cells, aren't as strong as the others and tend to produce mucus faster and bleed easier. According to Twogood, birth control pills, patches, and rings can sometimes cause an ectropion.
- Vaginal Tearing: During sex or particularly rough sex, your vagina can form cuts and tears that lead to bleeding. You are more likely to experience this cause of spotting after sex if you are also experiencing vaginal dryness, which Twogood says is more common with menopausal women.
- Infections: According to Twogood, cervical irritation or infection is a common cause of postcoital bleeding. This can include sexually transmitted diseases like chlamydia, gonorrhea, or trichomonas and non-STI infections like bacterial vaginosis and yeast infection. These infections can cause irritation, itching, and dryness of the vulva and the vagina, which can lead to spotting after sex.
- Polyps: A polyp is a growth that is almost always noncancerous but causes discomfort, commonly found in the cervix or the lining of the uterus. Polyps dangle, and when they move it causes irritation, which leads to bleeding. Sex can promote movement with a polyp and therefore lead to spotting after sex.
- Precancerous or Cancerous Cervical Cells: Spotting after sex could be a sign of a more serious issue, says Twogood. According to studies, postcoital bleeding is a poor indicator of cervical cancer but it's important to keep up with regular screenings from your healthcare provider to rule it out. Over the past decades, the incidence of women with postcoital bleeding from cervical cancer has decreased due to enhanced cancer screenings.
Risk Factors That Can Lead to Postcoital Bleeding
You may have a greater chance of bleeding after sex if you:
- Have cervical or uterine cancer
- Are going through menopause
- Are on certain types of hormonal contraception (which can lead to vaginal dryness)
- Recently had a baby or are breastfeeding
- Have a sexually transmitted disease or infection
- Aren’t fully aroused prior to intercourse
How to Prevent Bleeding After Sex
- Protection: “Using condoms routinely can decrease the risk of getting an STI,” says Twogood.
- Lubricant: Using a lubricant during intercourse can help with vaginal moisture, which may decrease postcoital bleeding, says Minkin.
- Dilation: Dilation, or stretching, of the vagina, happens naturally when women get turned on and have sex, a result of natural lubrication and the relaxation of the vaginal muscles. Dilating the vagina before sex can help to make sex easier and more comfortable.
Can Postcoital Bleeding Stop On Its Own?
It might, but it depends on what's causing the bleeding. According to Minkin, if the cause is vaginal dryness, it might go away on its own or stop after being treated with a lubricant. “However, if you do have persistent repeated episodes, you’ll want to check in with your provider for further evaluation,” she says.
When to See a Professional
According to the experts, a trip to the gynecologist might be necessary if bleeding after sex occurs more than once or twice, if there is heavy bleeding, or if you’re experiencing other symptoms like abnormal discharge or pain.
The Final Takeaway
While a single episode of postcoital bleeding is unlikely to be anything serious, repeated occurrences may be a sign of a more serious problem. If you are experiencing persistent spotting after sex or heavy vaginal bleeding, consult your doctor.
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