Causes of vaginal bleeding during or after sexual intercourse

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Vaginal bleeding after intercourse, also known as postcoital bleeding , is not uncommon among menstruating women. And it is even more common in postmenopausal women.

While bleeding can sometimes be a concern, in most cases the cause is relatively benign. The same can be said for those who experience bleeding during sexual intercourse. Many causes of postcoital bleeding are the same.

Illustration by Joshua Song. © Get Drug Information, 2018.

Overview

According to studies, up to 9 percent of menstruating women will experience vaginal bleeding after sex, regardless of their period. Studies say that 46 to 63 percent of postmenopausal women will experience dryness, itching, pain, etc. spotting or bleeding during or after intercourse due to hormonal changes that affect the elasticity of vaginal tissues.

While most of these causes of bleeding are not worrisome, there are times when bleeding can be a sign of a more serious problem. Find out below some of the most common causes of bleeding during and after sex.

Sexually transmitted infections

Sexually transmitted infections (STIs) such as chlamydia and gonorrhea are associated with a variety of vaginal symptoms, from pelvic pain, itching, and burning to vaginal discharge and frequent pain when urinating.

The inflammation caused by these STIs can lead to more rapid inflammation and rupture of superficial blood vessels, and the severity of the bleeding is often related to the severity of the infection .

Trichomoniasis is a type of STI caused by single-celled parasites. Cervical discharge and bleeding from the cervix are the two most common features of the disease. Like chlamydia and gonorrhea, Trichomonas vaginalis infection is easily treated with antibiotics.

Other STIs, such as syphilis and genital herpes , can cause open sores that tend to bleed when irritated. Although the sores usually appear on the outside, they can sometimes develop inside the vagina and, especially in the case of syphilis, they can be completely painless and unnoticed.

Benign polyps

Benign growths on the cervix (cervical polyps ) or uterus ( uterine or endometrial polyps ) are a common cause of bleeding during or after sexual intercourse. Cervical polyps generally develop in women between the ages of 40 and 50 who have had multiple pregnancies. Polyps are usually red or purple in color with a tubular structure rich in capillaries that can bleed easily when touched.

Uterine polyps are small, soft growths that protrude from inside the uterus. Polyps of this type are prone to bleeding between periods, after menopause, and during sexual intercourse. They also tend to develop in women between the ages of 36 and 55.

Most polyps are benign, but some of them can turn into cancer over time. Sometimes polyps disappear spontaneously, but in some cases, surgical removal may be necessary.

Other benign neoplasms of the genital tract, such as hemangiomas , can also cause postcoital bleeding, although these are much less common causes.

Cervical Ectropion

Cervical inversion is a benign disorder in which the cells that normally line the inside of the cervix are expelled through the cervical opening (opening of the cervix).

When this happens, the abnormal stretching of cervical tissue can lead to dilation of already fragile blood vessels and inflammation. As a result, bleeding is common due to intercourse, tampon use, and even the insertion of a dilator during a pelvic exam.

Reversal of the cervix can occur in adolescents, women taking birth control pills, and pregnant women whose cervix is softer than usual. This usually does not require treatment unless there is excessive vaginal discharge or bleeding.

Atrophic vaginitis

Postmenopausal women often bleed during or after intercourse because lower levels of estrogen literally thin the vaginal walls and produce less lubricating mucus. This is called atrophic vaginitis , a condition that also causes itching and burning in the vagina.

Atrophic vaginitis can also be treated with estrogen therapy, taken by mouth in pill form, as a skin patch or cream, or given intravaginally with a suppository .

However, oral estrogen replacement therapy carries some risks. According to the Women's Health Initiative , estrogen pills can only increase the risk of endometrial cancer and as such should be used for short-term treatment or replaced with another form of estrogen therapy. Vaginal lubricants can also relieve dryness and pain.

While younger women can also have vaginitis , usually caused by a bacterial or fungal infection, postcoital bleeding is a much less common symptom.

Endometriosis

Endometriosis occurs when the lining of the uterus (endometrium) extends outside the uterus. When this happens, endometrial tissue can adhere to the surfaces of other organs, often leading to excruciating pain and, in some cases, infertility.

Endometriosis affects 5 to 10 percent of women of reproductive age, and its cause and available treatments remain poorly understood.

The two hallmarks of endometriosis are painful intercourse and painful orgasm, both of which are caused by additional stress and pressure on already vulnerable tissues. Postcoital bleeding is not uncommon.

Hormone therapy, which is used to lower estrogen levels, often helps relieve pain. Pain and bleeding can also be reduced by changing the position you usually use during sex. Some, like the missionary position, put extra pressure on the vagina that can be relieved by the side-to-side position or other positions.

Injury

Although postcoital bleeding is often associated with infections and abnormalities of the uterus, vagina, or cervix, bleeding can also be the result of direct trauma to these vulnerable tissues.

It can be triggered by vigorous intercourse, which can lead to cuts, scrapes, or tears in the vagina. It is more likely if the vagina is dry, such as during menopause, breastfeeding, or excessive douching.

Even more frustrating, the bleeding can be the result of sexual assault or abuse. Forced penetration can severely damage the tissues of the vagina and lead to fissures that can heal and open repeatedly if not treated with medicine.

Cancer

Although cancer is a less likely cause of postcoital bleeding, it is one of the possible signs of cervical , vaginal , and uterine cancers.

In the United States, 14,000 women are diagnosed with invasive cervical cancer each year, resulting in more than 4,000 deaths.

Tumors can vary depending on the type of cancer, but they tend to feed on a dense and random network of blood vessels. As the tumor grows, these vessels may become tight and prone to rupture. Sometimes it can be due to sexual intercourse.

Sexless or sexless, bleeding is a common sign of cervical cancer. This could include:

  • Bleeding after menopause or between periods.
  • Heavy or longer periods than usual
  • Blood-stained vaginal discharge (sometimes mistaken for spotting)

To evaluate a woman for cervical cancer, a gynecologist will perform a pelvic exam, a Pap test, and sometimes a visual exam called a colposcopy . If the doctor suspects cancer, a biopsy sample may be taken for examination under a microscope.

Get the word of drug information

Bleeding during or after is not normal. Even if it happened as a result of an accidental injury, it's best to check, if only to find ways to avoid such injuries in the future.

If you're not sure what causes vaginal bleeding during sex, don't avoid visiting your doctor for fear of being diagnosed with cancer. In fact, cancer is one of the least likely causes. If cancer is indeed the cause of the bleeding, early diagnosis provides early treatment and a better chance of curing the malignancy before it becomes severe.

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