Bleeding after sex – causes, treatment and when to call your GP

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Bleeding after sex, also known as post-coital bleeding, is in most cases nothing to worry about, but in some rare cases it may be a sign of something more serious - we spill all on the common causes and when to see a doctor.

Bleeding after sex, also known as post-coital bleeding, is in most cases nothing to worry about, but in some rare cases it may be a sign of something more serious and should always be explored further by a health professional like your GP.

There are a few reasons why women may experience post-coital bleeding, from a lack of lubrication, through to more serious causes such as an STI. Vaginal bleeding may also present as a brown or pink discharge or ‘spotting’ of blood after sex, which as the name suggests, is small spots of blood on your underwear or toilet paper. 

Possible reasons for bleeding after sex

Loss of virginity – resulting in the hymen breaking.

Childbirth – following childbirth the vaginal tissues may be more vulnerable to injury.

Menopause – after the menopause, lower levels of oestrogen can make the vaginal walls thin, dry and inflamed.

Medications – some medications can cause vaginal dryness including some antidepressants, allergy pills and cold/flu remedies.

Chemicals – some chemicals cause vaginal dryness including laundry detergents, feminine hygiene products and swimming pool chemicals.

Douching – having sex immediately after bathing or showering can result in friction that causes the vaginal tissues to tear. 

Engaging in sex before arousal – not giving your body time to naturally lubricate.

Friction during sex – not enough lubrication and friction may cause the vaginal tissues to tear.

Sexually transmitted infections – STIs such as chlamydia and gonorrhea can cause vaginal bleeding and need to be treated as soon as possible.

Cervical ectropion – this can be a very common cause of bleeding which can be caused by hormonal changes, pregnancy and contraception, especially the combined oral contraceptive pill. The condition is caused when the cells from inside the cervix (the neck of the womb) grow on the outside surface of the cervix. These cells need more easily and can cause bleeding after contact during sex. It is benign and NOT linked to cervical cancer.

Polyps – Some women may find they develop small benign growths on their cervix called a polyp. As these are full of blood vessels they can bleed a lot. In some cases, your GP may send you to a specialist to assess whether it is definitely benign and look to remove it. 

Pelvic inflammatory disease (PID)– women may experience pain in the lower abdomen, vaginal discharge and irregular vaginal bleeding, alongside other symptoms. Most cases of PID are caused by a bacterial infection, in many causes an STI, that’s spread from the vagina or the cervix to the reproductive organs higher up. If you think you may have PID you should seek urgent medical advice.

Fibroids – Fibroids are non-cancerous growths that can grow on the inside of or around the womb and cause abnormal vaginal bleeding. 

Endometriosis – Endometriosis is when tissue, similar to that which normally lines the inside of the womb, grows outside of it.

Cervical cancer – In rare cases, bleeding after sex can be a sign of cervical cancer. Other symptoms may present as pain during or after sex, an unpleasant vaginal discharge and pain in the pelvis or lower back. 

Is it normal to bleed after losing your virginity?

It is perfectly normal for a woman to bleed after the first time they have sexual intercourse. Not all women may experience post-coital bleeding in this instance, but for it is also perfectly normal to experience some light vaginal bleeding.

This is because of the hymen breaking, which is a small piece of skin that covers the entrance of the vagina. The hymen may have broken prior to a woman losing her virginity, through activities such as sports and so in this case a woman may not experience bleeding the first time they have sex. 

Is my contraceptive pill making me bleed after sexual intercourse?

Certain types of contraception may cause bleeding at irregular times of the month which may coincide with sexual intercourse. Many of our contraceptive reviewers found they experienced spotting or bleeding on the pill, and in particular, those who use the progestogen-only pill (also known as the mini pill) such as Cerazette or Noriday found they experienced irregular bleeding. Often this will settle after the first 3 months of use. If you experience persistent irregular bleeding beyond this time, a change in the pattern of bleeding, new irregular or post-coital bleeding then speak to your doctor.

Is bleeding after sex a sign of pregnancy?

During pregnancy, your body goes through a variety of changes, particularly your cervix. You may experience a pinkish or brown discharge or some blood spotting after sex during the first few months of your pregnancy. This may happens due to the developing embryo implanting itself in the wall of your womb and bleeding may happen normally when your period would have been due. If you are concerned you are experiencing bleeding and may be pregnant, carry out a pregnancy test and contact your GP.

Postmenopausal bleeding after sex: should I call a doctor?

Oestrogen is what keeps your vaginal tissues healthy, so when a woman’s oestrogen levels drop during the menopause it can cause the vaginal walls to become thin, dry and inflamed. This is known as vaginal atrophy. Therefore when a woman has sex it can often lead to bleeding. Using a lubricant will help, but if the problem persists, or occurs at other times not in relation to sex, then make an appointment with your doctor. 

When to see a doctor for spotting or bleeding after sex?

Women’s experiences of post-coital bleeding may vary depending on the cause. If you have minor spotting or bleeding that goes away quickly you may not need to see a doctor. You should consider the need for a pregnancy test and STI tests to rule these out as a cause of bleeding. If you have persistent bleeding after sex then you should contact your GP, who will examine your cervix and investigate for serious causes.

If you have a normal cervix on examination but continue to have bleeding after sex, or the cervix looks abnormal, then your GP may refer you to a colposcopy clinic, where you will have a more detailed examination of the cervix. 

Sources:

NHS UK

Patient UK

Reviewed and edited on 18/02/21 in line with our content policy.

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