Bleeding after Sexual Intercourse: Is it Normal?

Genital bleeding after sexual intercourse is also called postcoital bleeding. The medical community typically uses this term to describe bleeding from the vagina, a fairly common incidence caused by a wide range of factors.

Most menstruating women experience postcoital bleeding, mainly from the cervix. Postcoital bleeding can affect any woman who engages in sexual intercourse. The source of this bleeding appears to be more diverse in women who are no longer seeing their monthly flow.

READ ALSO: 10 Reasons Not to Ignore Spotting or Bleeding After Period

The source of the postcoital 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.

What are the causes?

Common causes of bleeding after sex include:

Vaginal dryness

Vaginal dryness is among the most common causes of postcoital bleeding. When the vaginal skin is dry it becomes very vulnerable to damage. Mucus-producing tissues, such as those in the vagina, are at risk.

Common causes of vaginal dryness include:

  • Engaging in intercourse before arousal: Vaginal tissues secrete natural lubricants, which help to prevent dryness during sex and damaging friction during intercourse.
  • Genitourinary syndrome of menopause (GSM): This is also 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. This is because estrogen can impede 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 dry vaginal tissues.

Infections

Any type of infection can cause irritation of vaginal tissues, making them more vulnerable to damage. Such infections may include STIs, gonorrhea, chlamydia, yeast infections, PID, cervicitis, and vaginitis.

Injury

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.

READ ALSO: Vaginal cancer: Symptoms, Causes, and Treatment

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.

Cervical or endometrial polyps or fibroids

Polyps and fibroids are tiny benign growths. They mostly grow on the lining of the cervix or uterus, especially in menstruating women, and can cause pain and bleeding.

Endometriosis

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.

Cancers

Cancers that impact the reproductive system or urogenital tract can change vaginal tissues and hormone levels, causing them more exposed to damage. Postcoital bleeding is considered a common symptom of both cervical and uterine cancers.

Cervical dysplasia

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.

Anatomical abnormalities

Some people have differently shaped reproductive organs, which may increase the likelihood of painful friction and tearing.

Bleeding disorders

Diseases that cause abnormal bleeding or clotting can increase the risk of postcoital bleeding. Blood-thinning medications may also have this effect.

Risk factors

Common risk factors for postcoital bleeding include:

  • dehydration
  • vaginal dryness
  • forceful intercourse
  • immunosuppressant medications
  • immune conditions
  • family history of vaginal dryness or inflammation
  • history of cervical or uterine cancer
  • being perimenopausal, menopausal, or postmenopausal
  • diabetes
  • sex without the use of condoms
  • anxietyor reluctance around intercourse and intimacy
  • hypertension
  • lack of sexual experience
  • exposure to irritant chemicals or allergens
  • vaginal or uterine infections
  • douching

READ ALSO: Top 10 Home Remedies for Vaginal Dryness

Diagnosis

There are no 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.

Tests to properly diagnose the condition may include:

  • blood tests
  • culture tests for infection
  • endometrial biopsy
  • biopsies of abnormal growths and masses
  • a transvaginal ultrasound
  • a colposcopy
  • a pregnancy test

When to see a doctor

Speak with a doctor if postcoital bleeding is accompanied by additional symptoms, such as:

  • abnormal discharge
  • intense abdominal pain
  • vaginal burning or itching
  • unexplained weight loss
  • lower back pain
  • nausea, vomiting
  • lack of appetite
  • stinging or burning when urinating or during intercourse
  • abnormally pale skin
  • bladder or bowel symptoms
  • headache

Treatment options

There is no detectible cause of postcoital bleeding, so there is no direct course of treatment.

Potential treatment options include:

  • medications for viral infections
  • vaginal moisturizers
  • antibiotics or infections caused by bacteria, such as syphilis, gonorrhea, and chlamydia
  • surgery or therapy for cancer
  • 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
  • low-dose vaginal estrogen therapy, in the form of creams, suppositories, or rings, for vaginal dryness

READ ALSO: How To Get Rid of Vaginal Odor: Causes and Effective Home Remedies

Minor postcoital bleeding can often not be prevented. However, the following actions tend to greatly reduce the severity and frequency of bleeding.

Prevention

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 flax, olive oil, alfalfa, apples, walnuts, grapes, oats, almonds, sesame seeds, carrots, sunflower seeds, and lentils.

 

 

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