7 Causes of Bleeding After Sex: What It Means, When to Worry - Gynaecologist Explains

Dr Kajal Singh, Associate Professor at the Obstetrics and Gynaecology Department of NIIMS Medical College and Hospital, explains that people of almost any age can experience this condition. Understanding the causes helps determine when medical attention becomes necessary.

What Is Postcoital Bleeding?

Postcoital bleeding occurs when blood appears after sexual intercourse. This medical term describes a symptom rather than a disease itself. The bleeding can range from light spotting to heavier flow, and its severity often indicates the underlying cause.

Main Causes of Bleeding After Sex

Cervical Problems and Irritation

The cervix is a highly sensitive area that can become easily irritated. Inflammation, infections, or benign growths, such as polyps, can affect this delicate tissue. These conditions often cause spotting after sexual activity.

Cervical polyps, though typically benign, create surfaces that bleed easily when touched during intercourse. Similarly, cervical inflammation from various sources can make the tissue more prone to bleeding.

Vaginal Dryness

When natural lubrication lacks adequate levels, friction increases during intercourse. This friction can create microtears in the vaginal lining, which then bleed.

Women who are menopausal or breastfeeding particularly experience this issue. Hormonal changes during these periods reduce natural moisture production, making the vaginal tissues more vulnerable to injury.

Sexually Transmitted Infections (STIs)

Several STIs cause inflammation in reproductive tissues. Chlamydia, gonorrhea, and trichomonas commonly create cervical or vaginal inflammation that leads to postcoital bleeding.

These infections irritate sensitive tissues and make them more likely to bleed during or after sexual contact. Early detection and treatment of STIs prevent more serious complications.

Prolonged Sexual Activity

Intense sexual activity without adequate lubrication can traumatise vaginal tissues. Even slight injuries to these delicate areas can result in bleeding.

The vaginal walls and cervix can sustain minor damage when friction exceeds the tissue's tolerance. This cause often resolves with gentler approaches and proper lubrication.

Hormonal Factors and Contraceptives

Hormonal fluctuations affect vaginal and cervical tissues in various ways. Birth control pills, hormone therapy, and irregular menstrual cycles can all contribute to spotting after sex.

These hormonal changes alter tissue thickness and moisture levels, making bleeding more likely during intimate contact. Missed periods or hormonal imbalances create similar effects.

Medications and Medical Treatments

Certain medications thin the blood or affect tissue integrity. Blood thinners, antibiotics, and hormonal treatments can increase the risk of bleeding.

Medical treatments like radiation therapy or certain procedures also make tissues more fragile and prone to bleeding after minimal trauma.

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Cervical or Vaginal Cancer

Though rare, cancers of the cervix or vagina can present with postcoital bleeding as an early symptom. These serious conditions require immediate medical attention and professional diagnosis.

Cancer changes tissue structure and makes it more likely to bleed with contact. However, this cause remains uncommon compared to other factors.

When Medical Attention Becomes Necessary

Seek medical care when:

• Bleeding occurs frequently after sexual activity
• Heavy bleeding accompanies pain or discomfort
• Unusual discharge or strong odours develop
• Postmenopausal women experience any bleeding after sex
• Previous abnormal Pap smears create additional risk factors

Dr Singh emphasises that bleeding after sex "isn't always serious, but it's worth paying attention to, especially if it happens regularly."

Prevention and Management

Regular gynaecological checkups help maintain reproductive health and catch problems early. Many causes of postcoital bleeding respond well to treatment once properly diagnosed.

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