An estimated 0.7 to 9 percent of menstruating women experience postcoital bleeding, primarily from the cervix.
The source of this bleeding tends to be more varied in women who are no longer menstruating.
- The source of the bleeding is different, depending on whether a woman is menstruating.
- If vaginal bleeding after sex is related to menstruation, it is not considered postcoital bleeding.
- Anyone who engages in sexual intercourse can experience postcoital bleeding.
What are the causes?
Common causes of bleeding after sex include:
Bleeding after sex is fairly common and may have many different causes.
The friction and abrasion of intercourse can easily cause small tears and cuts in sensitive genital tissues.
Childbirth can also cause vaginal tissues to stretch and tear, sometimes making them more vulnerable to injury.
On the first occurrence of sexual intercourse, a small flap of vaginal skin called the hymen is often stretched and broken. The minor bleeding this causes can last 1 to 2 days.
Dryness is among the most common causes of postcoital bleeding. When the skin is dry it becomes extremely vulnerable to damage. Mucus-producing tissues, such as those in the vagina, are especially vulnerable.
Common causes of vaginal dryness include:
- Genitourinary syndrome of menopause (GSM): Once called vaginal atrophy, GSM refers to reduced lubrication, thickness, and elasticity of vaginal tissue.
- Ovary damage or removal: Severe accidents that damage the ovaries, or conditions that lead to their removal, destroy the body’s biggest source of estrogen.
- Childbirth and breast-feeding: During pregnancy, estrogen levels are very high. However, they drop almost immediately after childbirth, because estrogen can interfere with the production of breast milk.
- Medications that interfere with estrogen or dehydrate the body: Vaginal dryness can result from taking anti-estrogen medications, cold or flu medications, steroids, sedatives, several antidepressants, and calcium or beta channel blockers.
- Chemicals and other irritants: Allergens and chemicals in hot tubs, pools, products such as laundry detergents, scented lubricants, and condoms can all cause dryness.
- Douching: Douching can irritate and dry vaginal tissues.
- Engaging in intercourse before arousal: During sexual arousal, vaginal tissues secrete natural lubricants, which help to prevent dryness and damaging friction during intercourse.
Any type of infection can cause inflammation of vaginal tissues, making them more vulnerable to damage. These commonly include yeast infections, pelvic inflammatory disease, cervicitis, vaginitis, and sexually transmitted infections, such as chlamydia and gonorrhea.
Cervical or endometrial polyps or fibroids
Polyps and fibroids are tiny noncancerous growths. They commonly grow on the lining of the cervix or uterus, especially in menstruating people, and can cause pain and bleeding.
Glandular cells from the inside of the cervical canal can abnormally grow on the outside of the cervix. This condition usually clears up without treatment, but it can cause spotting and vaginal bleeding.
Endometriosis causes endometrial tissues, the tissues that line the uterus, to grow outside of the uterus. This can cause inflammation, usually in the pelvic region and lower abdomen.
Cervical dysplasia occurs when abnormal, precancerous cells grow in the lining of the cervical canal, which is the opening separating the vagina and uterus. These growths can irritate and eventually damage surrounding tissues, especially during intercourse.
Some people have differently shaped reproductive organs, which may increase the likelihood of painful friction and tearing.
Diseases that cause abnormal bleeding or clotting can increase the risk of postcoital bleeding. Blood-thinning medications may also have this effect.
Cancers that impact the reproductive system or urogenital tract can alter vaginal tissues and hormone levels, making them more vulnerable to damage. Postcoital bleeding is considered a common symptom of both cervical and uterine cancers.
Common risk factors for postcoital bleeding include:
- vaginal dryness
- aggressive intercourse
- immunosuppressant medications
- immune conditions
- family history of vaginal dryness or inflammation
- history of cervical or uterine cancer
- being perimenopausal, menopausal, or postmenopausal
- sex without the use of condoms
- anxiety or reluctance around intercourse and intimacy
- lack of sexual experience
- exposure to irritant chemicals or allergens
- vaginal or uterine infections
- high blood pressure
To diagnose postcoital bleeding, a doctor may perform a full physical exam, as well as some additional tests.
There are no national or international guidelines doctors use to diagnose or manage postcoital bleeding.
Many medical professionals will ask questions about individual and family medical histories and perform a full physical exam.
Additional tests may include:
- culture tests for infection
- biopsies of abnormal growths and masses
- a transvaginal ultrasound
- a colposcopy
- an endometrial biopsy
- blood tests
- a pregnancy test
If a doctor can not determine the cause of problematic bleeding, they may refer a woman to a gynecologist.
When to see a doctor
Talk with a doctor any time postcoital bleeding is severe, frequent, or continues for more than a few hours after intercourse.
Also speak with a doctor if postcoital bleeding is accompanied by additional symptoms, including:
- vaginal burning or itching
- abnormal discharge
- intense abdominal pain
- nausea, vomiting, or lack of appetite
- stinging or burning when urinating or during intercourse
- lower back pain
- unexplained fatigue and weakness
- headaches or lightheadedness
- abnormally pale skin
- bladder or bowel symptoms
In many cases, there is no single clear cause of postcoital bleeding, so there is no direct course of treatment.
Potential treatment options include:
- vaginal moisturizers
- antibiotics for infections caused by bacteria, such as gonorrhea, syphilis, and chlamydia
- medications for viral infections
- surgical removal, cryotherapy, or electrocautery in cases of cervical ectropion
- removal of polyps, especially those that cause significant bleeding or appear abnormal
- surgery or therapy for cancer
- low-dose vaginal estrogen therapy, in the form of creams, suppositories, or rings, for vaginal dryness
Bleeding after sex during pregnancy
Pregnancy, childbirth, and breast-feeding all cause major hormonal changes, most of which can make vaginal tissues more prone to damage. During pregnancy, minor bleeding during or after intercourse is common.
Talk with a doctor about any form of heavy or prolonged bleeding during early pregnancy. Seek immediate medical care for bleeding during the late pregnancy, as it can be a sign of preterm labor.
Staying hydrated may help to reduce postcoital bleeding.
Minor postcoital bleeding can often not be prevented. However, the following actions tend to greatly reduce the severity and frequency of bleeding.
Prevention tips include:
- staying hydrated
- using water- or silicon-based lubricants during foreplay and intercourse
- avoiding aggressive sexual acts
- using vaginal moisturizers on a daily basis
- avoiding scented or flavored feminine products
- always using condoms, especially when engaging with different sexual partners
- talking with sexual partners about anxieties and reluctance surrounding intercourse
- trying to become aroused before engaging in intercourse
- seeking medical advice and treatment for suspected infections
In addition, a person can use herbal supplements that have been scientifically shown to help reduce vaginal dryness and GSM symptoms. Some of these supplements include black cohosh, vitamin E, omega-3, and oil of primrose.
It may also be beneficial to consume foods rich in plant estrogens or phytoestrogens.
Foods rich in phytoestrogens include:
- olive oil
- sesame seeds
- sunflower seeds
Bleeding after sexual intercourse is a common occurrence, especially in people who are no longer menstruating or who have ovarian conditions.
In people who are menstruating, postcoital bleeding normally stops on its own. However, severe, chronic, or complicated cases require medical attention.
People who experience postcoital bleeding during periods of hormonal changes, such as menopause, pregnancy, or breast-feeding, should also talk with a doctor.