Bleeding after sex can be caused by vaginal dryness, infections, or cervical problems. See a doctor if it happens repeatedly.
Common causes
- Vaginal dryness.
- Infections, such as STIs.
- Cervical polyps or ectropion.
- Vaginal atrophy after menopause.
- Cervical cancer (rare).
When to worry
Bleeding after sex (postcoital) occurs in about 0.7% to 9% of women. It should always be checked.
What helps
Lubricant and more foreplay.
See a doctor
Soon, for a pelvic exam and Pap test.
Why bleeding happens
Bleeding after sex (postcoital bleeding) most often comes from the cervix, vagina or vulva. The tissue can be fragile or irritated, and friction can cause small tears.
Common causes
- Vaginal dryness, from low estrogen during breastfeeding, perimenopause, menopause or some birth control.
- Insufficient lubrication or arousal.
- Cervical ectropion, where cells from inside the cervical canal are on the outside, which is common in young women and pregnancy and is harmless.
- Infections: chlamydia, gonorrhea, trichomoniasis and pelvic inflammatory disease.
- Cervical or uterine polyps.
- Cervicitis.
- Fibroids.
- Vaginal atrophy.
- Trauma from rough sex or object use.
- Hymen tearing the first time, which may cause small amounts of bleeding.
- Cervical cancer or precancerous changes.
When to worry
Recurrent bleeding after sex, bleeding after menopause, pain, abnormal discharge, fever, or bleeding with other symptoms. Postcoital bleeding is reported by around 0.7% to 9% of women, and cervical cancer is found in a small minority of those with it.
What helps
- Use water based or silicone lubricant.
- Allow time for arousal.
- Communicate to adjust position or pace.
- Treat infections.
- Vaginal estrogen can help dryness after menopause (prescription).
Screening
Cervical cancer screening with Pap tests and HPV tests is recommended every 3 to 5 years for ages 21 to 65.
See a doctor
Any recurring bleeding, or bleeding with pain, should be evaluated. A doctor may do a pelvic exam, Pap smear, STI tests or ultrasound.
Emergency
Heavy bleeding that soaks a pad within an hour, or bleeding with severe pain, requires immediate care. For sexual assault, resources include RAINN at 800-656-4673.
Common medical causes
Bleeding after intercourse, called postcoital bleeding, affects up to about 9 percent of premenopausal women. Common causes are vaginal dryness (especially after menopause or while breastfeeding), cervical ectropion (a benign change in the cervix), cervical or vaginal infections such as chlamydia and gonorrhea, cervical polyps, friction or minor tears and, less often, cervical cancer. Hormonal birth control can cause breakthrough bleeding.
Evaluation and care
Using a water based lubricant, slowing down and allowing time for arousal can reduce friction related bleeding. A health care provider can perform a pelvic exam, test for infections and do a Pap test or HPV test. Cervical cancer screening is recommended from age 21. See a clinician if bleeding recurs, is heavy, happens after menopause or comes with pain, discharge or fever. Seek emergency care for heavy bleeding, soaking a pad an hour, or bleeding during pregnancy or after sexual assault.
Based on data from ACOG and the American Cancer Society
