Sexual activity naturally involves bodily fluids, but blood is not a fluid you want to see on your sheets. Although vaginal bleeding or spotting after sex, also known as postcoital bleeding, can be concerning, it is rarely a medical emergency. Here are some of the possible causes of vaginal bleeding after sex.
1. Vaginal Dryness
Friction during penetrative sex can tear sensitive vaginal tissues and cause bleeding if your vagina is not well lubricated. This can also make sex unpleasant or painful. Vaginal dryness is most commonly caused by hormonal changes, having sex before being aroused, and chemotherapy.
You can assist in restoring moisture to your vagina while avoiding sex-related pain or bleeding. Depending on the cause of the dryness, your healthcare provider can advise you on options such as lubricants, moisturizers, and vaginal estrogen.
2. Birth Control
Spotting after intercourse can be caused by any hormonal contraceptive. For example, when you start a new hormonal birth control, you may experience spotting between periods or breakthrough bleeding. It's even more common if you're taking low-dose or ultra-low-dose birth control pills, have an IUD, or have an implant.
3. Sexually Transmitted Infections
Sexually transmitted infections (STIs) can cause post-sex bleeding, especially if the infection causes cervicitis, an inflammation of the cervix. Rubbing an irritated cervix can cause bleeding.
Cervicitis can be caused by STIs such as chlamydia, gonorrhea, trichomoniasis, and herpes. Sex can irritate your cervix (the area between your vaginal canal and uterus) and cause bleeding if you have one of these STIs.
Pelvic inflammatory disease (PID), an infection of the reproductive organs, can also be caused by gonorrhea and chlamydia.
4. Uterine and Cervical Polyps
Polyps are tissue teardrops that form in the reproductive tract, either on the cervix or inside the uterus. They have numerous blood vessels that feed them and can bleed if jostled, so you'd see small amounts of blood after intercourse.
Cervical polyps can protrude from the cervix into the vagina and be touched or hit during sex. In addition, because your uterus is linked to your cervix, polyps within your uterus may become irritated during sex.
Polyps can occur in anyone, but they are more common in people over the age of 40 or who have entered perimenopause.
5. Bacterial Vaginosis or Yeast Infection
Infections of any kind can cause inflammation and irritation, which can lead to bleeding. Bacterial vaginosis (BV), caused by bacterial overgrowth, is the most common vaginal infection in women aged 15 to 44. Most women with vaginal organs will have at least one yeast infection in their lifetime.
However, bleeding is not the most common sign of bacterial vaginosis or yeast infection. The majority of people with BV have no symptoms. However, if the cervix becomes infected and inflamed, as in cervicitis, there may be some small amounts of blood seen after sex due to the rubbing.
6. Uterine Fibroids
Fibroids are noncancerous growths formed from the muscular tissue of the uterus. A fibroid is a benign tumor that grows from the uterine wall and can be as small as a pea or as large as a grapefruit. When fibroids are completely or partially within the uterine cavity, they can cause bleeding. This is because they contain a lot of blood, and the bouncing movements of sex can cause them to bleed.
7. Cervical Cancer
Cervical cancer is a type of cancer that affects the cervix, which is the area between your vaginal canal and the bottom of your uterus. The main symptom of cervical cancer is sex-related bleeding. Typically, the bleeding is light and painless. It's because cervical cancer is vascular, and sex friction can irritate tissue and cause bleeding. The good news is that if detected early, cervical cancer is highly treatable if detected early, thanks to screening tests such as a Pap smear.
The HPV (human papillomavirus) test also looks for high-risk HPV strains that can cause cervical cancer. Thousands of new cases of cervical cancer are diagnosed in the United States each year, and people can still die from it if it is not detected and treated.