Having vaginal bleeding after sex may be the first hint you know there may be something wrong. It's always essential to have it checked as soon as possible.
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As a woman, the only time that bleeding from your vagina is normal is during your menstrual period or the first few days after you've had a baby.
You may also bleed after a procedure like having a smear, but this should be light bleeding that will stop after a short while.
So when vaginal bleeding happens outside of these periods - take it seriously.
What is Bleeding After Sex?
Experiencing the passage of blood either during sex or a few minutes or hours later.
It could be spotting on your undies, or the bleeding could be heavier like a flow during your period. Regardless of the quantity, please do not ignore it.
Even if it happens just once, speak to your doctor so we can be clear about the cause and treat it appropriately.
Appearance of the Vagina, Cervix and Womb
To understand what causes bleeding after sex, let's take a quick look at how your reproductive tract looks internally.
We start with the vagina - an empty muscular tube that begins from the opening in your vulva and stretches up to end where the first part of the womb begins.
The first part of the womb is known as the cervix. Another name for this organ that slightly juts into the vagina is 'the neck of the womb'.
The womb is very muscular and well supplied with blood vessels.
So when we think about what causes bleeding after sex, we will be looking at problems that could affect these organs in particular.
Causes - Vaginal Bleeding After Sex
Most commonly, infection refers to sexually transmitted infections or STIs.
Infection with a sexually transmitted germ like Gonorrhoea or Chlamydia makes the vulva, vagina and cervix tissues inflame and bleed, causing a bloody discharge.
The friction of these sore tissues rubbing during sex can cause more bleeding afterwards.
A common complication of sexual infections we see is 'Pelvic Inflammatory Disease', PID.
PID is the term we give to infection of the upper reproductive tract in a woman, including the body of the womb, ovaries and fallopian tubes.
Most times, the cause of PID is a bacterial infection spreading from the vagina or the cervix to the reproductive organs higher up.
Infection in any of these tissues will cause vaginal bleeding after sex.
Another symptom of PID is painful vaginal sex.
A sexually active woman is more likely to have an STD or PID. Using a condom and practising safe sex helps to prevent these conditions.
Read about Preventing Ladies 'Toilet Infections'
Next, let us look at Vaginal Dryness as another cause for bleeding after sex.
The hormone estrogen is important for maintaining the healthy tissues of the vaginal tract.
In the absence of estrogen or when it's level reduces, the vaginal tissue changes as do the tissues of the vulva. They become thinner and dry.
Dryness makes it more likely that during sex when tissues rub together, it could be painful resulting in vaginal bleeding and from the vulva.
In which conditions can women experience vaginal dryness?
Well, there are quite a few:
- Natural events: Pregnancy, Breastfeeding, Menopause are some natural events when hormone changes affect the nature of the vagina tissues.
- Also, certain medicines could affect hormone levels and cause dryness and vaginal bleeding after sex.
- They include some birth control or contraceptive pills, or drugs used to treat depression.
- Others are certain blood pressure medicines or medicines used for treating cancer, i.e. chemotherapy.
- So, it's worthwhile having a look at the side effects of any drugs you are taking to work out what causes bleeding after sex.
Wounds or injury is another cause for many women to experience bleeding after sex.
Most often, this refers to trauma or injury a woman may experience following childbirth. During labour in a vaginal birth, a lot of first-time mothers develop a graze or tear to the area between the vagina and anus - we also call this area the perineum.
The injury can happen as the baby emerges from the vagina. In some cases, the doctor gives the woman a cut (episiotomy) to widen the opening and allow the baby to go through easier.
Most often we do this if: baby is in distress and needs to be born quickly, or there is a need to assist the vaginal birth using a vacuum or forceps.
A woman may also get a cut in labour if doctors are concerned she may tear herself when pushing very hard and straining to get the baby out, but the vagina is not wide enough.
So that explains how an injury may occur during childbirth.
Of course, these will heal but this may take time and depending on how deep the injury or how well it heals, having sex can result in bleeding from the wound.
Other Reasons for Vaginal Trauma
Another way vaginal trauma happens is when a woman is 'dry' or not well lubricated before sex.
Have you heard of the Bartholin's glands?
Well, these are two small peanut-sized glands behind the labia or the lips of the vulva.
They produce the fluid which flows into the vagina when you are aroused or sexually stimulated for lubrication.
Sex without adequate fluid can be painful and lead to tears or grazes, particularly if using sex toys too.
Other Causes of Bleeding After Sex that affect the Cervix.
Now let's look at another cause that affects the tissues of the cervix .
Firstly, let's consider benign growths known as polyps in the cervix.
These polyps are tissues that grow out into the vaginal canal so that thrusting movements by the penis rub or hit against them, making them a cause of bleeding after sex, or during intercourse.
Although they are abnormal growths, they do not mean the same as cancer which invades other tissues.
Cervical erosion refers to an altered or changed area on the surface of the cervix - your doctor may also call this cervical ectropion.
Erosion happens after the cells that are found inside the cervical canal develop outside (on its surface).
These tissues are quite different. The cells inside the canal are called soft cells and look redder than the cells on the surface, which are called hard cells. Soft cells located on the surface of the cervix are more likely to bleed when the penis touches it during sex.
How can you get erosions in the cervix?
Mainly from hormone changes - typical examples are being pregnant or being on the contraceptive pill. Having a cervical erosion does not mean the same as cervical cancer.
Cancer of the cervix or womb.
Though a rare cause of bleeding after sex, every sexually active woman must be aware of this relationship between possible cancer and bleeding after sex. This is why we encourage you to report any unexplained bleeding episode you have following sexual intercourse.
Key health measures you can take to prevent the development of cancer of the cervix are:
- Be aware of changes to your body and report them promptly to your Doctor.
- Ensure you attend your cervical smear tests regularly - do not miss them. Smears help us identify abnormalities in the cervix that if left untreated may lead to cancer in future.
- Take the HPV vaccine - Infection with the Human Papilloma Virus, HPV is one of the most significant risks linked to developing cancer of the cervix. It can be spread very easily among sexual contacts as it is mostly asymptomatic. Having the vaccine reduces your risk of developing the infection greatly.
So these are a few conditions you may have bleeding after sex.
Remember, if you cannot explain it - no matter how light it appears, speak to your doctor.
If you found this article helpful, watch our video on the causes of painful sex to learn more about that condition - or click the button below.
Let us know if you have any comments or questions about what causes bleeding after sex
- Pelvic Inflammatory Disease
- What causes a woman to bleed after sex?
- Episiotomy and Perineal Tears
- Cervical Erosion
Editing By AskAwayHealth
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