What causes bleeding after sex?

Many people with vaginas experience vaginal bleeding after sex at one time or another. In fact, up to 63% of postmenopausal people experience vaginal dryness and vaginal bleeding or spotting during sex. Also, up to 9% of menstruating people experience post-coital bleeding (after sex). Occasional light bleeding is usually not a cause for concern. If you have certain risk factors or have gone through menopause, bleeding after intercourse warrants a visit to the doctor.

Causes of bleeding after sex

Bleeding after sex is medically known as post-coital bleeding. It occurs in people of all ages. In younger people who haven't reached menopause, the source of bleeding is usually the cervix. In those who have already gone through menopause, the origin of bleeding is more varied. It can be from:

• cervix
• uterus
• lips
• urethra

In terms of causes, cervical cancer is the biggest concern. Especially for post-menopausal people. However, post-coital bleeding is more likely to be caused by a common condition.

Infections

Some infections can cause inflammation of the tissues in the vagina, which can lead to bleeding. These include:

• pelvic inflammatory disease
• sexually transmitted infection (STI)
• cervicitis
• vaginitis
• Genitourinary Menopause Syndrome (GSM)

GSM was formerly known as vaginal atrophy. The condition is common in perimenopausal and menopausal people and in those who have had their ovaries removed. As you get older, especially when your periods stop, your body produces less estrogen. Estrogen is the hormone responsible for regulating your reproductive system. When your estrogen levels are lower, several things happen to your vagina. Your body produces less vaginal lubrication, so your vagina can become dry and inflamed.

Lower estrogen levels also reduce the elasticity of the vagina. Vaginal tissues become more fragile, receive less blood flow, and are more susceptible to tearing and irritation. This can lead to discomfort, pain and bleeding during sex.

Vaginal dryness

Vaginal dryness can lead to bleeding. In addition to GSM, vaginal dryness can be caused by many other factors such as:

• breastfeeding
• childbirth
• having the ovaries removed
• certain medications, including cold medications, asthma medications, some antidepressants, and anti-estrogen medications
• chemotherapy and radiation therapy
• having sex before being fully aroused
• shower
• chemicals in feminine hygiene products, laundry detergents and swimming pools
• Sjögren's syndrome, an inflammatory disease of the immune system that reduces the moisture generated by the body's glands

Polyps

Polyps are non-cancerous growths. They are sometimes found on the cervix or the endometrial lining of the uterus. A polyp dangles like a round pendant on a chain. The movement of the polyp can irritate the surrounding tissue and cause bleeding from small blood vessels.

Vaginal tearing

Sex, especially vigorous sex, can cause small cuts or scrapes in the vagina. This is more likely to happen if you have vaginal dryness due to menopause, breastfeeding or other factors.

Cancer

Irregular vaginal bleeding, including bleeding after sex, is a common symptom of cervical or vaginal cancer. In fact, it was the symptom for which 11% of people diagnosed with cervical cancer first sought treatment. Post-menopausal bleeding can also be a symptom of uterine cancer.

Are you at higher risk of bleeding after sex?

You may be at increased risk of post-coital bleeding if:

• have cervical or uterine cancer
• are perimenopausal, menopausal, or postmenopausal
• recently had a baby or are breastfeeding
• are not fully aroused before intercourse
• shower frequently

Consult a doctor for these symptoms

The symptoms you may experience along with post-coital bleeding vary depending on the cause. If you're not menopausal, don't have other risk factors, and only have small spotting or bleeding that goes away quickly, you probably don't need to see a doctor. If you have any vaginal bleeding after menopause, see your doctor right away. You should also see your doctor if you have any of the following symptoms:

• vaginal itching or burning
• burning or burning sensation when urinating
• painful intercourse
• heavy bleeding
• severe abdominal pain
• lower back pain
• nausea or vomiting
• unusual vaginal discharge

What happens when you see your doctor?

You can visit your primary care doctor or gynecologist for post-coital bleeding. Your doctor will ask you about your symptoms, such as how long and how badly you have been bleeding. They may also ask about the color of the blood.

As your symptoms are related to sexual activity, your doctor may also ask about your sexual history. For example, they may ask if you use condoms regularly or if you have more than one sexual partner. Depending on your symptoms and sexual history, your doctor may recommend a physical exam. Examining the area can help your doctor find the source of the blood. Post-coital bleeding can come from your vaginal walls, cervix, urethra or vulva.

To help determine what is causing the bleeding, your doctor may also order tests such as a Pap smear, pregnancy test, and vaginal cultures to look for STIs. Many are hesitant to visit a doctor about a sexual health issue if they find pelvic exams uncomfortable. However, seeing a doctor about post-coital bleeding will not necessarily require a pelvic exam.

Prevention of bleeding after sex

Determining how to prevent post-coital bleeding depends on what caused the bleeding in the past. For most people, using water-based or silicone-based lubricants will help prevent bleeding caused by vaginal dryness and friction during sex. If you're using condoms, an oil-based lubricant can damage it. Water-based lubricants are recommended.

It can also help to have sex slowly and stop if you feel pain. Regular use of vaginal moisturizers can help keep the area moist and make you feel comfortable. If your post-coital bleeding symptoms are related to a medical condition, you can talk to your doctor about the best options for preventing future episodes.

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