Vaginal Bleeding After Sex

Why It Happens and What to Do About It

Bleeding during or after sex is common and not always a reason to worry. As many as 9% of people have experienced vaginal bleeding after sex that was not related to their menstrual period. It's also called postcoital bleeding.

Between 46% and 63% of postmenopausal people will experience dryness, itching, tenderness, or bleeding during or after sex that's related to hormonal changes affecting the vaginal tissue.

This article will go over seven common reasons for bleeding during or after sex. While many of the causes are not serious, it's still a good idea to let your healthcare provider know if you are bleeding outside of your typical menstrual cycle.

Why Do Some Women Bleed During or After Sex?

Verywell / Joshua Seong  

Sexually Transmitted Infections

Sexually transmitted infections (STIs) like chlamydia and gonorrhea are associated with vaginal symptoms like pelvic pain, itching, burning, vaginal discharge, and frequent, painful urination.

Each STI has its own symptoms, but the inflammation from any infection can cause vaginal bleeding. For example:

  • Trichomoniasis is caused by a single-celled parasite. Cervical discharge and cervical bleeding are two of the most common symptoms of the disease.
  • Syphilis and genital herpes cause open sores that may bleed if irritated. The sores often appear on the outside (externally) but they can also develop inside the vagina. The sores can be painless and may go unnoticed until they bleed.

STIs need to be diagnosed by a healthcare provider. They will talk to you about your sexual history and do some tests to check for STIs. The treatment for STIs depends on what is causing them. For example, you may need to take antibiotics or antiviral medications.

You can also prevent STIs by practicing safe sex and getting vaccinated against some infections, like hepatitis B.

Benign Polyps

Benign growths on the cervix (cervical polyps) or uterus (uterine or endometrial polyps) are common causes of bleeding during or after sex.

  • Cervical polyps tend to develop in people who are in their 40s and 50s and who have had multiple pregnancies. The polyps are typically red or violet with a tube-like structure that has a lot of capillaries and can bleed easily when touched.
  • Uterine polyps are small, soft lumps of tissue protruding from within the uterus. They are prone to bleeding between periods, during sex, and after menopause. They tend to develop in people between the ages of 36 and 55.

Most polyps are not cancer (benign) but some can develop into cancer. Your provider can diagnose the polyps and test them to see if they could be cancerous. Polyps sometimes go away without treatment, but surgical removal might be necessary in some cases.

There are also noncancerous growths in the genital tract, such as a hemangioma (a tumor made up of blood vessels), that can cause postcoital bleeding. However, these growths are less common causes of bleeding during or after sex.

Cervical Ectropion

Cervical ectropion is a noncancerous condition where the cells that normally line the inside of the cervix protrude outside through the opening of the cervix (cervical os).

This can cause the already-fragile blood vessels in the cervix to dilate and become inflamed. As a result, bleeding is common with intercourse, the use of tampons, and the insertion of a speculum during a pelvic exam.

Cervical ectropion can occur in adolescents, people taking birth control pills, and pregnant people whose cervixes are softer than normal.

Your provider can diagnose cervical ectropion by doing an exam. The condition usually does not require treatment unless there is excessive vaginal discharge or bleeding.

Atrophic Vaginitis

Postmenopausal people often bleed during or after sex because decreasing estrogen levels in their bodies cause the walls of their vaginas to thin and produce less lubricating mucus. This is referred to as atrophic vaginitis. The condition usually causes vaginal itching and burning.

Younger people can also have vaginitis, often from a bacterial or yeast infection. However, postcoital bleeding is not usually a symptom of these conditions.

A healthcare provider can usually diagnose vaginitis by doing an exam. They can also test a sample of fluid from inside the vagina (culture) to check for an infection.

Atrophic vaginitis can be treated with estrogen therapy. It can be taken orally in pill form, applied to the skin as a patch or cream, or inserted vaginally as a suppository.

However, oral estrogen replacement therapy does have downsides. For example, estrogen-only pills can increase the risk of endometrial cancer in people who still have their uterus. The pills should be used as a short-term treatment or combined with progestin to protect the lining of the uterus.

Vaginal lubricants can often ease dryness and decrease pain related to vaginitis.

Endometriosis

Endometriosis occurs when cells that are similar to those that make up the lining of the uterus (the endometrium) grow outside of the uterus. The endometrial tissue can attach to the surfaces of other organs and cause excruciating pain. Some people with endometriosis also experience infertility.

There is a range of symptoms of endometriosis depending on which organs are affected by it. For many people with the condition, painful intercourse, painful orgasms, and postcoital bleeding are common.

It can be difficult to diagnose endometriosis. A provider will talk with you about your symptoms and might want to do a surgery called a diagnostic laparoscopy to look for lesions. They can also take a sample of tissue to look at under a microscope and confirm the diagnosis.

Treatment for endometriosis can include medications and surgery. Hormone therapy to reduce estrogen levels reduces pain for some people with endometriosis and others find relief when they have surgery to remove the lesions.

If you have endometriosis and experience pain or bleeding during sex, changing positions may help. For example, the missionary position can place added stress on the vagina and cause pain. A side-to-side position might be more comfortable.

Trauma

Postcoital bleeding is often associated with infections and abnormalities of the uterus, vagina, or cervix, but bleeding can also because when these vulnerable tissues are injured.

For example, vigorous sex can lead to cuts, scrapes, or tears on the vagina. This is more likely to happen when the vagina is dry (for example, during menopause, breastfeeding, or from excessive douching).

Bleeding can also be caused by sexual abuse or violence. For example, forced penetration can severely damage vaginal tissues and lead to fissures. The wounds can repeatedly heal and reopen unless they are medically treated.

Cancer

While cancer is a less likely cause of postcoital bleeding, this symptom is one of the possible signs of cervical, vaginal, and uterine cancer.

Cervical Cancer Stats

Nearly 15,000 people are diagnosed with invasive cervical cancer in the United States every year, leading to more than 4,000 deaths.

The tumors can vary depending on the type of cancer. The blood vessels that supply them can burst when the tumor gets bigger, which can lead to bleeding. Sometimes, the bleeding is triggered by sex but can also happen at other times.

Other symptoms that are common with cancer of the reproductive system include:

Your gynecologist can perform a pelvic exam, Pap smear, and a visual exam called a colposcopy to diagnose cancer. They might also take a tissue sample to look at under a microscope.

The treatment for reproductive cancers depends on the type and stage but can include chemotherapy, radiation, surgery, and immunotherapy.

Summary

Noticing blood during or after sex can be alarming, especially if you're not menstruating. Some causes include a sexually transmitted infection, benign polyps, cervical ectropion, atrophic vaginitis, endometriosis, trauma, and cancer.

If you're experiencing bleeding when you're having sex or after sex, it's important to tell your provider. They can diagnose the cause and recommend the right treatment.

Frequently Asked Questions

  • Does light spotting after sex mean I'm pregnant?

    Light spotting can be a sign of pregnancy but there are also other causes. The only way to find out for sure is to talk to your provider.

  • Can a yeast infection cause bleeding?

    A yeast infection can cause bleeding but usually only if it has progressed to vaginitis. A yeast infection more often causes itching, redness, pain while urinating or during sex, and an odorless, white discharge.

  • How long does postcoital bleeding last?

    How long postcoital bleeding lasts depends on the cause—specifically, whether the bleeding is vaginal or cervical.

    For example, direct trauma to the vaginal walls can cause heavy and bright-red bleeding that lasts for a short time. Cervicitis can cause bleeding after sex that varies in how long it lasts.

  • Why does sex hurt?

    There are many possible reasons why sex may hurt. For example, STIs like chlamydia and herpes can cause painful sex for anyone.

    In people with a vagina, pain during or after sex can be caused by vaginal dryness related to menopause, low sexual arousal, vaginismus, irritation caused by latex or spermicides, and endometriosis.

    In people with a penis, pain during sex can be caused by a tight foreskin, prostate gland inflammation, or small tears in the foreskin.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Tracee Cornforth
Tracee Cornforth is a freelance writer who covers menstruation, menstrual disorders, and other women's health issues.