Why am I bleeding after sex? Is it normal?
A bloody discharge after intercourse with or with no pain can be light or heavy depending on the cause.
Some women experience light pink spotting while others encounter heavy bleeding that can even last 2 days after intercourse.
Spotting can be a source of worry, especially during pregnancy. Here are causes and how to deal with it.
Vaginal bleeding after intercourse is also called postcoital bleeding. It may be normal if it is your first time, but abnormal if it occurs every time post-coital.
Gynecological studies of 1995 and 2000 found a relationship between endometrial cancer and bleeding every time after sexual intercourse.
It should be taken seriously since it can mean a serious disease, infection or injury. You may notice the blood immediately after intercourse or within 1 or 2 hours.
- You’re not on period. It is not your first time or you are not a virgin, but there’s spotting or bleeding every time after sex. What does it mean?
- In most cases, postcoital spotting is a bit normal especially if things were a bit rough. It should be very light rather than heavy. This should not worry you.
- But when heavy or continuous and accompanied with pain, you should see a doctor immediately. Spotting after sex with no pain can also mean there is an underlying health problem.
- This is usually the case when you experience this symptom every time you engage in intercourse. Do not consider it normal.
“In two studies in the United States, postcoital bleeding led to a diagnosis of cervical cancer between six and 10 percent of the time.” [HealthyWomen]. It is strongly recommended, therefore, that you see a gynecologist if you experience this problem.
What causes vaginal bleeding after sex?
In summary, the following are the 12 common causes:
- Friction during rough intercourse
- Vaginal polyps and uterine polyps
- Inflammation of the cervix
- Vaginal cuts and tears from childbirth
- Vaginal dryness and atrophy during menopause
- Vaginal yeast infections
- Pelvic inflammatory disease (PID)
- Cervical erosion (cervical ectropion)
- Precancerous cervical dysplasia
In most women who have not reached menopause, the source of the blood after sex is the cervix. You may experience light pink bleeding or spotting after various forms of sexual intercourse.
The cause is light trauma or injury even if you have a healthy cervix. In such a case, there can be pain.
However, on many other occasions, postcoital spotting with no pain may occur. Below is a detailed look at the causes listed above.
1. Friction during rough sex
Friction can be caused by normal penile penetration during rough sex. If the penis rubs the cervix or the lower end of the uterus, you are likely to experience postcoital bleeding. Friction during intercourse may lead to painful sex for the woman. The result may be light spotting or even heavy bleeding just after intercourse.
- Bleeding that occurs after being fingered could be caused by injury to the vaginal walls.
- When you bleed after the first time may be caused by the torn hymen. This is common in virgins having intercourse for the first time.
- Rough sex is a major cause of friction especially if done without foreplay or lubrication. It can result in bleeding and pain.
Remedy: If you experience spotting with pain, try doing things differently. Discuss with your partner so that you can try doing things gently. If you have a dry vagina, try adequate foreplay. If that does not work, you can try safe lubes to help reduce friction during sexual intercourse.
2. Cervical and vaginal polyps
Light pink discharge after penetrative intimacy may be caused by cervical polyps. “A cervical polyp is a common benign polyp or tumor on the surface of the cervical canal. They can cause irregular menstrual bleeding but often show no symptoms.”
- In most cases, postcoital bleeding in women with vaginal polyps occurs when the cervix it touched.
- Intercourse can trigger spotting and so can a cervical exam.
Treatment: Endometrial polyps (uterine polyps) are removed surgically to stop the bleeding. A little pain may be involved, but your doctor will prescribe painkillers such as ibuprofen to relieve the pain.
3. Inflammation of the cervix (Cervicitis)
Inflammation of the cervix is also called cervicitis. It is quite common in women especially those prone to vaginal bacterial and yeast infections. Symptoms of cervicitis include bleeding between periods, discharge, and spotting after intercouse. Other than postcoital bleedings, some women may experience the following symptoms:
- Frequent vaginal discharge, usually grayish or pale yellow.
- Pain during sex.
- Painful or difficult urination. You may also experience painful urination if you suffer from cervicitis.
- Abdominal and pelvic pain.
Treatment: If not caused by a sexually transmitted infection (STI), pain and discharge might not need treatment.
Most infections, if mild, may clear on their own. However, your doctor may choose to treat the primary infection causing the bleeding in order to stop the symptom.
4. Vaginal cuts and tears
Your symptoms might also be related to tearing and cuts in the vagina. Vaginal cuts and tearing may happen as a result of childbirth and rough sexual intercourse.
- The bleeding from vaginal cuts should be minor. Or just spotting.
- If you experience a heavy period-like discharge, the cause may be something different. See a gynecologist as soon as possible for proper examination and treatment.
According to Dr. Edwin Huang, MD, a gynecologist at Massachusetts General Hospital in Boston, “Many women notice vaginal cuts and tears after sexual intercourse, and most of the time these tears and abrasions are normal.”
5. Vaginal dryness and atrophy
Women who experience post-coital vaginal bleeding every time may be suffering from dryness or vaginal atrophy (atrophic vaginitis). Atrophy of the vagina refers to the “thinning, drying and inflammation of the vaginal walls due to your body having less estrogen.” [Mayo Clinic]
This occurs mostly during menopause and can produce distressing symptoms including pain during sex, burning during urination and even urinary incontinence. Other Symptoms of vaginal atrophy include increased rate of urinary tract infections, tightening and shortening of the vaginal canal and occasional light bleeding during and after sex.
- Your doctor may at first recommend using a vaginal moisturizer to get rid of dryness in the vagina.
Replens, Hyalo Gyn, Vagisil Feminine Moisturizer are some of the options you may have to consider. Moisturizers last longer than lubricants and are preferred for mild dryness.
- If there is much discomfort during sex that results in bleeding, try using a water-based lubricant.
- Estrogen therapy helps to balance estrogen in the body and treat vaginal atrophy; and subsequently postcoital bleeding.
6. Vaginal yeast infections
Yeast infections are very common in women of all ages. Chronic vaginal yeast infections can cause a discharge containing blood spots. This can occur when there is an overgrowth of the yeast cells in the vagina due to a weakened immune system, too much sugar in the body and poor hygiene.
General symptoms of vaginal yeast infections include:
- Vaginal discharge that is white and clumpy.
- Vaginal itching.
- Burning inside the vagina.
Treatment: Yeast infections are treated using anti-fungal medications. Your doctor will prescribe a one to three-day dose of antifungal ointment or cream. Tablets and suppositories may also be given to get rid of the yeast cells.
It is also called trich. It is a “common sexually transmitted disease (STD) that is caused by infection with a protozoan parasite called Trichomonas vaginalis.” Its symptoms are not consistent but most people who get infected with the parasite may not show any symptoms. When present, its symptoms may include:
- A thin discharge that smells bad.
- A burning and itching vagina.
- Discomfort during urination.
- Light bleeding, especially after sex.
- Painful intercourse.
- Swelling, redness or irritation of the vulva.
Treatment for trichomoniasis involves the use of antibiotics. If you experience bloody vaginal discharge after sex during pregnancy, ensure that you get treatment during the early trimesters as it could be trichomoniasis. This infection can cause complications during pregnancy. It has also been linked to pre-term delivery.
8. Pelvic inflammatory disease (PID)
Another cause of vaginal bleeding after being sexually active and when not on period is pelvic inflammatory disease (PID). It is the “infection of the female upper genital tract, including the womb, fallopian tubes and ovaries.” [NHS Choices].
It is caused by a bacterial infection that travels further up the female reproductive system. While it does not cause obvious symptoms, a woman may experience the following:
- Lower abdomen pain.
- Painful sex felt deep inside the pelvis.
- Heavy period-like flow after intercourse and between periods.
- Heavy periods may also be a symptom of PID.
- Pain when passing urine.
- Unusual yellow or green vaginal discharge.
Treatment: A course of antibiotics may be prescribed if you are diagnosed early enough. This treatment can last for 14 days. Both injections and tablets are available options. Your doctor will also advise you to avoid sexual intercourse during this time.
9. Cervical erosion
Cells lining the inside of the cervical canal can grow out and be found on the outer surface of the cervix (neck of the womb). It can leave the area eroded, inflamed and even infected. Some women experience light pink discharge after intercourse during pregnancy or postpartum because of vaginal erosion.
Bleeding in early pregnancy for almost no reason may be related to cervical ectropion. You may experience pain when urinating and abnormal vaginal discharge if you have this condition. Treatment involves cauterization, antibiotics or cryotherapy.
10. Cervical dysplasia
This refers to a precancerous condition where there are changes in the epithelial cells that line the cervix. The condition is strongly linked with the human papillomavirus (HPV), which is sexually transmitted.
If diagnosed during your routine vaginal pap test, its prognosis is almost always successful when treatment is applied. Cervical dysplasia can lead to cervical cancer if left undiagnosed and untreated. Common symptoms (when present) include the following:
- Abnormal vaginal bleeding between periods.
- Bleeding during sex and after sex when not on period.
- Genital warts may present.
- Unusual vaginal discharge.
- Low back pain.
- Light bloody discharge after intercourse.
Treatment: According to the University of Maryland Medical Center, “Surgical removal of abnormal tissue is still the treatment of choice for cervical dysplasia.” Conventional medications are not an applied treatment for cervical dysplasia.
Alternative therapies and complementary alternative medicine may help in getting rid of cervical dysplasia. Studies have shown that treating a nutritional deficiency of folate, vitamin C an beta-carotene can help in reducing the effects of cervical dysplasia.
11. Chlamydia and spotting after intercourse
Sexually transmitted infections and diseases can also lead to spotting after intercourse. Chlamydia is one of the most common sexually transmitted infection that can cause abnormal pink spotting after intercourse.
Chlamydia is caused by a bacteria. When left untreated, it can spread and infect the eye, urethra, anus, fallopian tubes, cervix and even vagina. Common chlamydia symptoms in women include the following:
- Pain during intercourse.
- Pain that is felt in the abdomen.
- Burning when urinating.
- Frequent urge to pass urine.
- Bloody discharge after coitus
- Abnormal bleeding between menstrual periods, etc.
Chlamydia is treated with a course of antibiotics. According to Dr. Ed, “Azithromycin and Doxycycline are the two most commonly prescribed antibiotics to treat Chlamydia.”
Gonorrhea is a venereal disease that causes inflammatory discharge from the vagina or urethra. It is contagious and is spread through sexual contact with an infected person. It may not show clear symptoms but in women, the following symptoms may present after the incubation period. A few of its symptoms include:
- Irregular menstrual bleeding.
- Unusual vaginal discharge
- Painful and frequent urination
- Pain in the abdomen or belly
- Pain during sexual intercourse.
- Pink eye.
- Abnormal vaginal bleeding during sex or after sex. You may also bleed between periods.
Gonorrhea is treated using antibiotics. If not treated early, complications may develop at a later stage. Ensure that you take the prescribed dose to completion for effective treatment of the bacteria. Also, avoid sexual contact at least 7 days after completing the prescribed dose of antibiotics.
Is it normal?
Bleeding during and after sexual intercourse is common. But is it normal to bleed after sex? According to Zoc Doc doctors, “It is harmless to bleed a little bit after sex if you don’t have sex regularly.” It should, however, stop after some time. It is not normal to have postcoital bleeding that is persistent or recurrent on a frequent basis.
- It is normal to bleed after the first time because your hymen will tear in the process.
- After rough sex, you can expect a little spotting, which is normal and should stop almost immediately.
- You might also get light bleeding if you just finished your period and had sexual intercourse immediately.
- A little spotting may be normal once in a while, but heavy bleeding is not normal.
Heavy bleeding is not normal, unless it is during period, especially for most people on birth control. Heavy or abnormal bleeding may be a side effect of the birth control pill.
Intrauterine Device (IUD)
Some people may suspect that Minera IUD devices may cause light spotting after sex. Birth control measures such as intra-uterine devices are implanted to prevent unwanted pregnancy.
According to Health Line Networks, “In most cases, IUDs don’t cause bleeding after sex.”
However, one of the most common side effects of IUDs is infections. When you are prone to infections, you are likely to spot after sex. The most commonly used IUD devices are hormonal IUDs (e.g. Mirena and Skyla) and copper IUDs (e.g. ParaGard).
When there’s no pain
Why am I bleeding but there’s no pain? Pain may be associated with sex, endometriosis and a few other conditions. Some of the causes of the bleeding are already discussed above.
It can be difficult to determine the source of the bleeding especially when you don’t have any other symptoms such as pain.
- If you continue to experience light pink spotting after sex without pain, see a gynecologist immediately.
- Infections can present no symptoms at all, except for spotting and bleeding.
If you have this problem during pregnancy, it is advised that you see a doctor as soon as possible for an examination. Some infections such as gonorrhea and chlamydia can affect the development of the baby.
Bleeding during pregnancy
Spotting during pregnancy can happen especially during implantation. But how long after sex is implantation bleeding? Implantation is when the fertilized egg attaches itself to the uterine wall. This occurs about 4 weeks after sex or after conception. Implantation may be accompanied by light spotting.
The American Pregnancy Association notes that this kind of symptom during pregnancy may be due to the tender and sensitive nature of the cervical lining.
Women on the pill or depo
Women on the birth control pill may experience quite a number of side effects that may include postcoital bleeding. Irregular bleeding and menstrual periods may also be related to pills and Depo-Provera CI birth control shots.
“Many birth control pill users have noted breakthrough bleeding after sex or even heavy exercise.” [WebMD]. Even teenagers who use such pills may experience the problem. Other symptoms of birth control pill include:
- Breast tenderness
- Intermenstrual spotting
- Mood swings
- Decreased libido and
- Vaginal discharge
If you are on the pill and experiencing spotting after intercourse, consider talking to your doctor or gynecologist for an alternative that can get rid of the symptoms.
Hysterectomy is a surgery that is performed to remove a woman’s womb (uterus). This is done in cases of cancer, some chronic infections and as a treatment for severe pain. Hysterectomy surgery can come with some side effects as well.
According to Life After Hysterectomy, women should expect some bleeding after the surgery to remove the uterus. A little bleeding can be seen even years after the surgery. This is highly attributed to the rapid decrease in estrogen levels that can lead to atrophic vaginitis.
The resultant lack of lubrication (dry vagina) can result in pain during sex followed by light spotting. This can be worsened with rough sex that can cause trauma to the vaginal epithelium and result in minor bleeding.
When to see a doctor
Since it is not normal to see blood after intimacy, it is important to know when to see a doctor. Your bleeding may be normal when it is not regular premenopausal. Pap tests and testing for STDs should be done to rule out any infections. See a doctor if:
- You experience heavy vaginal bleeding that lasts more than six hours after intercourse.
- You are postmenopausal and still experience it postcoital.
- You are at risk of cervical cancer.
- If the bleeding is accompanied by pain after sex.
- If the episodes repeat themselves every time you are intimate with your partner.
- If you have fever, abdominal pain or pain in the pelvic region.
Sources and references
- Obstetrical & Gynecological Survey:
November 1995 – Volume 50 – Issue 11 – pp 779-780
- The American College of Obstetricians and Gynecologists:
April 2002 – Volume 99 – Issue 4 – p 663–670
Tabor, Ann; Watt, Hilary C.; Wald, Nicholas J.
Endometrial Thickness as a Test for Endometrial Cancer in Women With Postmenopausal Vaginal Bleeding
- Mayo Clinic: Vaginal atrophy treatment
- CDC: Trichomoniasis – CDC Fact Sheet
- John Hopkins Medicine: Vaginitis and its variants
- NHS Choices: Pelvic inflammatory disease
- University of Maryland Medical Center: Cervical dysplasia causes, diagnosis, prevention and treatment
- WebMD: Gonorrhea Symptoms and Treatment
- The American Pregnancy Association: Bleeding During Pregnancy