Is Bleeding After Sex Normal? - Causes and Risks of Spotting After Sex

Unless you’re on your period, experiencing bleeding after sex can certainly feel alarming. It may not be super common, but it’s certainly not unheard of (and not necessarily a sign of something bad). According to a 2014 study conducted by the Womack Army Medical Center, post-coital bleeding that isn't period-related occurs in anywhere from .7 to 9 percent of women who menstruate.

Post-coital bleeding isn't necessarily a sign of something bad.

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Sloane York, MD, an obstetrician-gynecologist at Rush University Medical Center in Chicago, says that the source of the blood is typically the cervix. Blood can also originate from inside the uterus or the side of the vagina, depending on the cause. For young women, a number of reasons could be behind post-coital bleeding. “Some women will have generally irregular periods and on-and-off bleeding, and may notice [themselves] bleeding more prominently after sex,” York says.

Bleeding can also be due to normal changes in the cervix. Hormonal changes such as those that occur during pregnancy can cause some women to develop cervical ectropion, for example: That's where the cervical canal turns outward, exposing tissue with fragile blood vessels that bleed easily when they're touched by, say, a penis or fingers. (This generally doesn't require treatment or have symptoms other than post-coital bleeding.) Benign cervical polyps, which are “abnormal growths of polypoid tissue from the cervix and are rarely related to cancer,” can also make the cervix prone to bleeding.

Bleeding could, however, signify that you have an STI, which you definitely want to take care of.

Another cause of post-sex bleeding is inflammation of the cervix, which can be triggered by sexually transmitted infections (STIs) — chlamydia is the most common culprit. York notes that infections like STIs can lead to pelvic inflammatory disease (PID). “PID requires two weeks of antibiotics and is a serious infection for many women,” she says. “PID or even chlamydia or gonorrhea can lead to infertility, especially if untreated.”

Post-coital bleeding could be the result of more long-term conditions too.

Post-coital bleeding can also be a sign of something potentially more serious, such as cervical dysplasia (meaning abnormal cell growth), cervical cancer, or trauma to the vagina. These causes are relatively rare in young women, but when it comes to menopausal women, York says “any bleeding must be evaluated by a doctor and can be from polyps of the cervix or uterus, or from pre-cancerous or cancerous changes to the uterus or cervix.”

It's also possible for menopausal women to experience bleeding after sex from small vaginal tears — the vagina thins during menopause as a result of the decreased estrogen production — and it’s important to get checked out to be sure.

A doctor can help you figure out why you're bleeding — and what to do about it.

York says that if you’re experiencing very heavy bleeding (soaking through a normal maxi pad in an hour), or experiencing severe pain that isn’t improving with ibuprofen or acetaminophen, head to the emergency room. Otherwise, make an appointment with your gynecologist for some time in the next few weeks to discuss the bleeding.

“Your doctor will ask you questions about your periods, the frequency and amount of bleeding, if you have other irregular bleeding besides just after sex, and if you have pelvic pain, fevers, or other issues,” York says. After discussing those questions, you’ll undergo a physical checkup. “[Your doctor] will perform a speculum exam to look at the cervix (and may perform a Pap smear for cervical cancer screening if you have not had a recent one over the previous couple years) and often will do testing for sexually transmitted infections like chlamydia, gonorrhea, and trichomonas (swabs done in the vagina).”

If your doctor does find an infection of some sort, you’ll need to go through the appropriate treatment plan (like antibiotics for STIs) in order to stop the bleeding and rid your body of the infection. Moving forward, using condoms will help you avoid contracting another infection and dealing with the bleeding that could potentially result. If the cause was tearing in the vagina, York says using lubrication during sex may prevent bleeding; and in menopausal women experiencing vaginal thinning, estrogen cream could help.

In some cases, however, the issue may resolve itself — or you might not be able to take specific preventative actions. “If the reason for bleeding is a cervical polyp or normal cervical changes, then these are things that won’t necessarily return and we cannot really prevent it from happening again,” York says.

Regardless, if you’re experiencing anything out of the ordinary or that concerns you, there’s no harm in making an appointment with your doctor to discuss it and possibly get an exam. It's the first step toward getting a treatment plan if you need one, or getting peace of mind if the cause of your bleeding is benign.

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