Many girls and women experience irregular bleeding after they begin menstruating. This can be caused by a number of things, including hormonal contraceptives, stress, and simply having a slightly irregular menstrual cycle.
Though the majority of menstruating, sexually active women are used to some irregular bleeding or spotting, it can be alarming to experience bleeding outside of your period – and particularly after sex.
If you’re concerned about bleeding after sex, read on to find out whether you should visit a doctor.
Common Causes of Post-Coital Bleeding
For many women, post-coital bleeding is simply a symptom of sexual intercourse. Friction during sex or particularly rough sex can cause damage to the vaginal tissue and result in bleeding.
This kind of bleeding is more likely to occur amongst menopausal women (or women who have had their ovaries removed) due to increased vaginal dryness; one study showed that 63% of menopausal women had experienced bleeding or spotting during sex . It is also more common in women who experience vaginal dryness due to breastfeeding, chemotherapy, douching, or taking certain medications. Vaginal dryness can be improved with hormone replacement therapy, and the use of lubrication during sex.
Another common cause of bleeding after sex is infection. The common sexually transmitted infections chlamydia and gonorrhoea can both cause bleeding after sex, along with pain when urinating, unusual vaginal discharge, and abdominal pain. Both chlamydia and gonorrhoea can be treated with antibiotics.
Bleeding can also be caused by pelvic inflammatory disease and polyps (non-cancerous growths that grow on the cervix and inside the uterus). PID should be treated with antibiotics, while polyps that are causing symptoms can be removed surgically.
The conditions listed above are not usually cause for concern, provided they are addressed by a doctor and treated appropriately.
Post-Coital Bleeding Caused by Cancer
If you are bleeding after sex on a fairly regular basis you should visit a doctor. This is because bleeding after sex can sometimes be a symptom of cervical or endometrial cancer. In women over 25, bleeding after sex is more likely to be a sign of cervical cancer. In women over 40, bleeding after sex can be a sign of either.
Other symptoms of cervical and endometrial cancer include:
Bleeding between periods
Unusual vaginal discharge
At a more advanced stage, loss of appetite, tiredness, bone pain
In the UK, cervical cancer accounts for 2% of all cancer diagnoses in women ; endometrial cancer accounts for 5% . The survival rate for both is fairly good, particularly with early diagnosis. For this reason it’s important to visit a doctor if you are experiencing irregular bleeding.
Preventing Post-Coital Bleeding
To prevent bleeding after sex, there are several things you can do.
If the bleeding is unrelated to the sex, but caused by your hormonal contraception (several types can cause irregular bleeding or spotting), you can talk to your GP about switching to an alternative type.
If the bleeding is caused by vaginal dryness, you can try using lubricants. Menopausal women may also benefit from using vaginal oestrogen or other HRT treatments.
If past bleeding has been caused by a sexually transmitted infection, you can take steps to practise safer sex. Use condoms and dental dams if you aren’t sure your partner is STI-free, and always wash sex toys between uses. If you’re engaging in any risky sexual behaviours, you should get regular STI tests; many STIs (including chlamydia and gonorrhoea) don’t initially cause symptoms, but can progress and worsen if untreated, leading to pain and bleeding.
If past bleeding has been caused by rough sex, try alternative sexual activities that don’t cause damage to the vagina.
Lastly, if you experience significant or ongoing post-coital bleeding again in the future, you should visit a doctor to have it checked out. Bleeding can be caused by a variety of different things, so it should always be flagged with your GP.
Getting Tested with The STI Clinic
At The STI Clinic you can order home test kits for chlamydia and gonorrhoea, both of which can cause bleeding after sex. We also offer a test kit for bacterial vaginosis; this condition does not cause post-coital bleeding, but you may experience vaginal discharge with a strong fishy smell, particularly after sex.