Postcoital Bleeding: Why You May Bleed After Sex

Chances are that if you're reading this, you've had an unexpected surprise after sex. Postcoital or after sex bleeding can be alarming at first, not to mention a real mood killer. This type of bleeding is not related to your menstrual cycle and the amount of bleeding after sex can range from a scant amount of spotting to a heavy, bright red, sheet-soaking puddle.

Where the Bleeding Comes From

Obviously, there are many different ways to have sex. When talking about postcoital bleeding, we are referring to bleeding that happens after sex when vaginal penetration is involved. That means postcoital bleeding can happen after vaginal penetration by a penis, a dildo, a partner’s finger…you get the point.

Anatomically, the two parts of your body that can bleed from the friction or relative trauma of vaginal sex are your vagina and your cervix.

Reasons for Vaginal Bleeding

When your vagina bleeds after sex, it's most likely the result of direct trauma to the wall of your vagina. This is called a vaginal laceration and the bleeding is bright red and can be quite heavy.

Typically, the vagina doesn’t tear with intercourse. If the vagina is not well lubricated, the friction caused by vaginal penetration can tear the wall of your vagina. You might experience inadequate vaginal lubrication if any of the following occur:

  • Vaginal penetration occurs before you are aroused enough to self-lubricate.
  • Your estrogen levels are low. This happens during breastfeeding and with menopause.
  • You've had unusually rough sex or a foreign object is used for vaginal penetration. This includes if your partner has genital piercings or implants, such as metal barbells.

Although not common, vaginal lacerations are usually the cause of postcoital bleeding that is heavy enough to bring a woman to the emergency room after sex.

The vagina has a rich blood supply and these types of lacerations bleed a lot. Usually, it means stitches or suturing are needed to stop the bleeding. Sometimes it even means a trip to the operating room.

Reasons for Cervical Bleeding

Unlike the vagina, bleeding from the cervix after sex usually isn’t heavy enough to bring you to the emergency room in the middle of the night. Typically there's a limited amount of bright red blood. It can be so minimal that you only notice it when you're wiping yourself or changing your sheets. Even though it may be minimal, it's still important to discuss any bleeding after sex with your healthcare provider.

Essentially there are four reasons why your cervix may bleed after sex, including:

  1. Cervical ectropion: The cervix has two regions and two types of cells. The outside of the cervix has the same type of cells as the vagina but the inside or canal of the cervix has a different type of cell. The cells that cover the cervix act as a barrier and are resistant to the vaginal environment, including the friction of intercourse. However, the cells that line the canal of the cervix are much more fragile. Cervical ectropion describes a condition or an anatomical variation in which the canal of the cervix is turned inside out, exposing these more fragile cells to the vaginal environment. Pregnancy and birth control pill use can be associated with these changes. These cells bleed very easily when touched even lightly. If you have this variation of your cervix, it is very likely you will have postcoital bleeding.
  2. Cervical polyps: The cells that line the canal of the cervix can also make polyps. Endocervical polyps are generally benign growths. Because they have such a rich blood supply, they bleed easily. These polyps develop in the canal of your cervix but as they grow they stick out of the end of your cervix, putting them in the perfect position to be irritated and bleed during sex.
  1. Cervicitis: Inflammation of the cervix, called cervicitis, can also cause bleeding after sex. Chlamydial infection is the most common cause of acute cervicitis. In the early stages, a chlamydial infection has no real symptoms but it is a serious sexually transmitted infection that can affect your fertility. It's very important to see your healthcare provider if you are having any new onset postcoital bleeding.
  2. Cervical cancer: This is by far the most serious cause of postcoital bleeding. However, it's also the least likely cause. This is especially true if you have been seeing your healthcare provider for routine cervical cancer screening. Of course, cervical cancer is the first thing you will find in an internet search for postcoital bleeding. If you're reading this, take a big cleansing breath and don’t panic. There are many other potential causes of your postcoital bleeding and there's no need to assume it's cervical cancer right away. However, it's important to discuss postcoital bleeding or any other concerns you have with your healthcare provider.

    See Your Healthcare Provider

    If you're having postcoital bleeding, you may also be experiencing abnormal uterine bleeding that isn't related to sex. Approximately 30 percent of women who bleed during sex also have other episodes of abnormal bleeding outside of their regular monthly period. 

    Postcoital bleeding is typically painless. Only about 15 percent of women with bleeding after sex will also complain of pain with sex, called dyspareunia.

    It's important that you see your healthcare provider if you're experiencing postcoital bleeding.

    To help your doctor determine the cause of your bleeding, think about how you would answer the following questions:

    • Do you have a new sex partner?
    • When did the bleeding start?
    • Do you practice safe sex?
    • Do you use any sex toys or other foreign objects during sex?
    • Do you have pain with sex?
    • Do you always bleed after sex or only at certain times of the month or in certain positions?
    • Do you have bleeding outside of your regular period that is not related to sex?

    You may feel embarrassed or awkward about discussing bleeding after sex with your doctor, but your sexual health is an important part of your overall health and it's very important for you to bring it up, even if your doctor forgets to ask. And if your doctor doesn't make the conversation easy for you, maybe you should think about finding a new one.

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