Bleeding After Sex: Causes and More

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Postcoital bleeding — or bleeding after sex unrelated to menstruation — typically happens because of conditions affecting the vagina or cervix, such as an infection, injury, or growth.

 Most of these conditions aren’t dangerous, but they may require treatment, so it’s important to see your doctor.

“I have had only one patient in almost 19 years of practice that had postcoital bleeding for which we could not find a cause. Everyone else has had something that needed fixing,” says Rebecca Perkins, MD, a professor of obstetrics and gynecology at Boston University Chobanian and Avedisian School of Medicine and an ob-gyn at Boston Medical Center. “I cannot emphasize this enough: Anyone with postcoital bleeding needs to see a healthcare provider and have a speculum exam to look and see what is going on.”

The following are some of the most common causes.

Cervical Polyps

“Cervical polyps are small, benign growths on the cervix that can easily bleed during or after intercourse due to their fragile nature,” says Rakhee Patel, MD, an ob-gyn with Pinewood Family Care, a Direct Primary Care practice in New Jersey. These growths, which can also appear on the uterus, seldom develop into cancer.

“Your healthcare provider can see a polyp when they look with a speculum,” Perkins says. “Often, they can remove the polyp quickly and painlessly during your clinic visit.”

Other than bleeding after sex, symptoms of polyps include heavy menstrual periods, bleeding between periods, and white or yellow mucus.

 If you’re experiencing symptoms, your doctor may recommend removing and testing polyps for abnormal cells.

Infection

Inflammation of the cervix, or cervicitis, is another common cause of postcoital bleeding, says Priyanka Gokhale, MD, an assistant professor in the department of obstetrics and gynecology and the physician house adviser at the University of Illinois in Chicago. Vaginal inflammation can have a similar effect.

“Infections in the vagina or cervix can inflame and irritate the skin, causing it to bleed during sex,” Dr. Perkins says. “This can be from sexually transmitted infections like gonorrhea, chlamydia, or trichomoniasis — or from infections that are not sexually transmitted, like a yeast infection. Your healthcare provider will usually test for infections if you have bleeding after sex.”

Some infections, including herpes, can also cause sores that bleed when touched. Although these usually develop on the vulva, they can occur inside the vagina or cervix.

Depending on the infection type, your doctor may recommend antibiotics or an antifungal medication to clear it.

 Although many infections are curable, most are contagious and don’t go away on their own, so it’s important to receive a diagnosis and treatment.

Besides bleeding after sex, symptoms of infection can include dyspareunia (painful sex), painful urination, unusual discharge, itching, burning, abdominal pain, a strong odor, warts, sores, and fever.

Vaginal Dryness

Minor injury or tears to the vaginal, cervical, or vulvar tissue can cause bleeding after sex as well, Dr. Gokhale says. “This can commonly happen if there’s vaginal dryness or atrophy or not enough lubrication,” she says.

Vaginal dryness and atrophy can happen at any age, but commonly occur after menopause because of low estrogen, Gokhale says. Because estrogen also drops during breastfeeding, new moms often experience vaginal bleeding and dryness, too.

 “If you have very low estrogen levels, then the skin of the vagina may be thin and sometimes tear slightly with sex. This is usually painful,” Perkins says.

Postcoital bleeding can also be a side effect of combined hormonal birth control pills, which suppress the body’s natural estrogen production, leading to vaginal dryness, Gokhale says.

Using lubrication during sex often helps, but your doctor may recommend switching contraceptives or using an estrogen-based medication if low hormones are to blame.

Cervical Ectropion

“Cervical ectropion is when some of the fragile gland cells that usually are on the inside of the cervix migrate to the outside of the cervix,” Perkins says. “This is normal due to hormone fluctuations — and can sometimes happen in people who are pregnant or who are taking birth control pills.”

Patel explains that ectropion can cause bleeding because the cervical cells are delicate and prone to irritation. It’s common and happens to about 17 to 50 percent of people with cervixes.

Your healthcare provider can diagnose ectropion by doing an exam. It usually doesn’t require treatment, but if your cervical bleeding persists, your doctor may recommend medication or a procedure to eliminate the irregular cells.

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