Bleeding after Sex
Bleeding after sexual intercourse is known in medical terms as postcoital bleeding.
This can be an alarming symptom that can be rather distressing for the woman who experiences this.
Is it normal to bleed after sex?
While it may be fairly common for women to experience a minor bleeding or some spotting when they have sexual intercourse with vaginal penetration for the first time, bleeding after sex should never be assumed to be normal or taken lightly.
Women who experience postcoital bleeding will require further evaluation and medical care by an experienced doctor. This is regardless of whether it is the first time it has happened to you, or whether you have had recurrent episodes before.
Bleeding after sex is a medical condition that should never be ignored!
What are the Causes of Postcoital Bleeding?
There can be a whole spectrum of various causes of bleeding after sex, ranging from benign causes to more sinister causes including cervical or uterine cancer.
The blood can arise from local causes from the vagina, cervix or in rare instances, the womb.
It is important for your healthcare provider to take a thorough history, perform a proper pelvic examination and conduct the necessary investigations to determine the cause of postcoital bleeding.
Sexually transmitted infection
Sexually transmitted infections are one of the most common causes of bleeding after sex. Vaginal bleeding is a common symptom, and may in fact be the only symptom of a sexually transmitted infection. Hence, it is important to see your primary care doctor early if you experience any vaginal bleeding after sex, so that any sexually transmitted disease can be ruled out, and if needed, you and your sexual partner can be treated early. Left undiagnosed, untreated sexually transmitted infections can lead to complications like pelvic inflammatory disease and infertility.
Cervical infections cause inflammation which lead to bleeding after sex. There may also be abnormal vaginal discharge present. Some common causes include sexually transmitted infection, or yeast or bacterial infection.
Cervical polyps are little growths that can arise from the cervix or the cervical opening. They are made up of soft tissue which causes them to bleed easily. This happens especially with direct contact which leads to vaginal bleeding after sex.
Cervical ectropion is more simply known as cervical erosion. Cervical erosion is extremely common and occurs on the superficial aspect of the cervical opening. This can be diagnosed when an experienced doctor performs a proper physical exam with a pelvic examination.
Unfortunately, bleeding after sex could also be caused by sinister causes such as cervical cancer. The risk of cervical cancer is higher in someone with a Human Papillomavirus (HPV) infection. Other risk factors also include family history, smoking and multiple sexual partners. Is is important to understand that cervical cancer can be prevented with regular pap test screening. Abnormal cells can be picked up early and treated successfully. A pap test is recommended for all sexually active women from the age of 21 according to the American Cancer Society.
Abrasions and tears
Over vigorous sexual activity or vaginal dryness can lead to minor abrasions and tears in the vaginal walls or vaginal tissues which can cause some light bleeding after sex.The use of vaginal moisturizers such as lubricants may help to reduce friction and tears.
Atrophic vaginitis or genitourinary syndrome
Atrophic Vaginitis is mainly caused by vaginal dryness. This is a common cause of bleeding after sex in post menopausal women. This is because of reduced estrogen levels after menopause. This causes significant vaginal dryness which can lead to pain or vaginal bleeding after sex. Certain medications such as topical estrogens or vaginal moisturizers may be prescribed to improve this.
In rare instances, vaginal cancer can also be the cause of postcoital bleeding.
Endometrial polyps are little growths that arise from the womb. These polyps consist of soft tissue and blood vessels which causes it to bleed easily. This may also lead to vaginal bleeding after sex.
Pregnancy is an important cause that should not be missed. A pregnancy test should be performed especially in women who belong to the reproductive age group.
Amongst the different types of gynaecological cancers, uterine cancers are less common than cervical or vaginal cancer as a cause of postcoital bleeding. But this should also not be missed out. Womb cancers more often present as prolonged bleeding, heavy irregular menstrual bleeding or post menopausal bleeding.
Treatment of postcoital bleeding depends on the cause. The most important step is to first get an accurate diagnosis on the cause of postcoital bleeding with proper investigations and examination. This requires the expertise of an experienced women’s health doctor.
An accurate diagnosis will then guide the treatment process to successfully treat the problem.
Conditions like sexually transmitted infections need to be treated promptly due to the risk of pelvic inflammatory disease, while polyps may require removal.
More sinister causes like cervical or vaginal cancer will require an urgent referral to a specialist for further management.
When should you see a Doctor?
Vaginal bleeding after sex should never be ignored. If you experience any episodes of bleeding after sex, you should consult your doctor. This is regardless of whether it is the first time it has happened. If this has happened more than once to you and you have not been properly evaluated, do consult a women’s health doctor as soon as you can.
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Dr Michelle Chia
After graduating from the National University of Singapore, Dr Michelle's journey allowed her to train in Women's Health and Aesthetic Medicine. Her experience has led her to be featured on multiple media platforms including Radio Stations and prominent Magazines like Her World, Women's Weekly and CLEO. Her work has also received recognition both locally and internationally in several Medical Conferences.
Ezra Clinic is a Women’s Health, Wellness and Aesthetic Clinic that is conveniently located at the top floor of Royal Square Medical Suites in Novena, Singapore’s Medical Health Hub.
Helmed by Dr Michelle Chia, Ezra Clinic is your chosen one stop clinic for all your Women’s Health and Wellness needs.