Why Am I Bleeding After Sex?

Is it normal to bleed after sex? Vaginal bleeding or spotting after sex, or postcoital bleeding, can be concerning, but it's usually not a medical emergency. A vaginal infection, sexually transmitted infection (STI), and cervical cancer may cause bleeding after sex. A common cause of bleeding during sex is a lack of lubrication or foreplay.

Bleeding after sex could be a sign of pregnancy: Some people experience light bleeding during the first 20 weeks of pregnancy. Changes to the cervix (the lowermost part of the uterus) during pregnancy may cause bleeding after sex. Read on to learn what causes bleeding during and after sex, as well as when to contact a healthcare provider.

Is Bleeding After Sex Normal?

A small amount of bleeding, or spotting, during or after sex is probably normal if it happens rarely. You might want to talk to a healthcare provider, in contrast, if you have regular bleeding. Bleeding can be a sign of a health concern that requires treatment, such as an infection or, although rare, cervical cancer.

Causes

Bleeding might sometimes be a side effect of hormonal birth control, especially at the start. Regularly bleeding during or after sex might also be a sign of vaginal dryness, an infection, or growth.

Vaginal Dryness 

Friction during penetrative sex can tear sensitive vaginal tissues and lead to bleeding if your vagina is not well lubricated. Vaginal dryness can also make sex painful or uncomfortable.

Causes of vaginal dryness include:

• Chemotherapy: This treatment can damage the ovaries so they no longer produce the hormones estrogen and progesterone. Decreased hormone levels lead to atrophic vaginitis, which causes the vagina to become dry, pale, and smooth.
• Hormonal changes: Estrogen levels decrease after giving birth, while breastfeeding, and leading up to and after menopause. Menopause is a common cause of atrophic vaginitis.
• Intercourse: Friction can lead to small tears in the vaginal tissue. Make sure you have enough foreplay before penetration and use plenty of lube.

Birth Control

Hormonal birth control can lead to bleeding during and after sex. Spotting between periods, or breakthrough bleeding, typically happens when you start a new hormonal birth control. Breakthrough bleeding is even more common if you use low- or ultra-low-dose birth control pills, an intrauterine device (IUD), or an implant.

Your body will usually adjust after a few months, and breakthrough bleeding will stop. Bleeding does not always go away, especially if you have an implant. Some people using hormonal birth control may also experience vaginal dryness. This may cause tearing and some bleeding during and after sex.

Infection 

Sexually transmitted infections (STIs) and other infections that affect the reproductive organs may cause bleeding during and after sex. These include:

• Pelvic inflammatory disease (PID): Gonorrhea and chlamydia, which are common STIs, can lead to PID. This infection affects the reproductive organs. PID can cause bleeding after sex, pelvic pain, spotting between periods, and unusual vaginal discharge and odor. If untreated, PID may lead to scar tissue and infertility.
• STIs: Chlamydia, gonorrhea, herpes, and trichomoniasis (trich) can cause cervicitis, or inflammation of the cervix. The cervix can bleed with rubbing if it's irritated.

Other Conditions 

Other causes of bleeding during or after sex might include:

• Cervical cancer: Although rare, cancer of the cervix might cause bleeding during or after sex. Cancerous tumors are highly vascular, meaning they have a lot of blood vessels. Friction can irritate the growths and cause bleeding as a result.
• Polyps: These teardrop-shaped growths form in the reproductive tract on the cervix or inside the uterus. Polyps are usually benign (non-cancerous) and rarely become cervical or endometrial cancer. These growths have many blood vessels feeding them and can bleed if they are irritated during sex.
• Uterine fibroids: These are benign growths that typically grow out of the uterine wall. Fibroids can be as small as a pea or larger than a grapefruit. These growths are filled with blood, so they may bleed if they become irritated during sex.

Risk Factors 

Anyone can have bleeding during and after sex, including people who menstruate, no longer have a period, or have entered menopause. You may notice red spots on the bed, on your underwear, or between your legs after sex. 

You might be likely to bleed during or after sex if you:

• Are going through perimenopause (the transition to menopause) or menopause
• Experience sexual abuse
• Have an STI or vaginal infection 
• Have recently given birth or are breastfeeding
• Use douche products

How To Stop Bleeding After Sex

You might be able to stop bleeding during and after sex by treating the underlying cause. Treatment might include oral or topical medications for a yeast infection and BV. Antibiotics can treat STIs caused by bacteria or parasites. Other medications can alleviate symptoms of those caused by viruses.

Talk to a healthcare provider if you think a polyp is the cause of bleeding. Treatment is not always necessary. Some people require surgery, depending on the size and other symptoms.

Most people do not know they have uterine fibroids. Treatment is usually not necessary unless the fibroid grows too large. A healthcare provider may consider medication or surgery to remove the fibroid. Cervical cancer is also highly treatable if diagnosed early.

When To Contact a Healthcare Provider

Talk to a healthcare provider right away if you have frequent or severe bleeding during and after sex. You should also contact a healthcare provider if you:

• Are pregnant or might be pregnant
• Develop a fever or abdominal pain
• Feel lightheaded or weak
• Have bleeding after menopause
• Have bleeding during or after sex that lasts longer than one week
• Have severe pain, especially if you are not on your period

STIs often do not cause symptoms. It's important to see a healthcare provider if you've been or think you've been exposed to an STI. They might administer a pelvic exam, blood tests, or imaging tests to diagnose the underlying cause. A healthcare provider might also ask you to take a pregnancy test if you might be pregnant.

Preventing Bleeding After Sex

You might be able to prevent bleeding during and after sex if you have vaginal dryness. These treatments help restore moisture to your vagina and avoid sex-related pain or bleeding:

• Hormone therapy
• Lubricants
• Prescription estrogen (e.g., creams, rings, suppositories, or tablets)
• Vaginal moisturizing creams

Talk to a healthcare provider if you think your birth control is the cause of bleeding. They may recommend alternative birth control methods. 

A Quick Review

Bleeding during and after sex on occasion usually is not a big deal. Friction from sex, especially if your vagina is dry, can cause tearing and bleeding. It's possible that bleeding is related to a more severe infection or, although rare, cervical cancer. Talk to a healthcare provider if you consistently notice bleeding and have other abnormal symptoms.