Bleeding after sex: causes and solutions

Bleeding after sex, also known as post-coital bleeding, can be both concerning and uncomfortable. It's important to understand the potential causes, what you can do about it, and when to seek medical advice, as a clear understanding can help ease your mind and guide you toward the appropriate next steps.

Spotting or light bleeding 

Spotting or light bleeding after sex is common and can occur for several reasons. It might be due to slight trauma to the vaginal walls or cervix during intercourse. This type of vaginal bleeding is usually not a cause for concern unless it happens frequently [2]. 

Minor injuries to the delicate tissues of the vagina or cervix can occur, especially during vigorous or prolonged sex. Using adequate lubrication and being gentle can help prevent these minor injuries and reduce the likelihood of post-coital bleeding [3]. 

Vaginal infections 

Infections such as bacterial vaginosis, yeast infections, or sexually transmitted infections (STIs) like chlamydia or gonorrhoea can cause post-coital bleeding. These infections can make the vaginal tissues more sensitive and prone to bleeding. Symptoms might include unusual discharge, itching, or an odour. If you suspect an infection, see a doctor for appropriate testing and treatment [4]. 

Benign and malignant changes in the cervix 

Changes in the cervix, both benign and malignant, can lead to bleeding after sex. Conditions such as cervical polyps, which are non-cancerous growths on the cervix, can cause bleeding. More serious conditions like cervical cancer can also be a cause. Regular cervical screening (smear tests) is crucial for early detection and treatment of cervical abnormalities [2]. 

Cervical polyps are benign growths that can be easily removed if they cause symptoms. Cervical ectropion, where the inner cervical cells are present on the outer surface, can also cause bleeding but is usually harmless. However, any persistent post-coital bleeding should be evaluated by a healthcare provider to rule out more serious conditions like cervical cancer [2]. 

Bleeding after intense or prolonged sex 

Sometimes, vigorous or prolonged intercourse can cause minor tears or abrasions in the vaginal walls, leading to bleeding after sex. Using enough lubrication and being gentle can help prevent this. If the bleeding is heavy or persists, consult a healthcare professional [5]. 

This type of bleeding is usually temporary and resolves on its own. However, repeated instances should be discussed with a healthcare provider to rule out underlying issues [5]. 

Hormonal changes and imbalances 

Vaginal dryness, often caused by hormonal changes such as those during menopause, breastfeeding, or due to certain medications, can lead to post-coital bleeding. Using a water-based lubricant can help reduce friction and prevent bleeding. If dryness is a persistent issue, a doctor might prescribe oestrogen creams or other treatments [6]. 

According to HSE.ie, the most common causes of postmenopausal bleeding include: 

• Atrophic vaginitis: Inflammation and thinning of the vaginal lining caused by lower oestrogen levels. 
• Endometrial atrophy: Inflammation and thinning of the womb lining caused by lower oestrogen levels. 
• Cervical or womb polyps: Non-cancerous growths that develop due to hormonal fluctuations or chronic inflammation. 

• Endometrial hyperplasia: Thickened womb lining caused by obesity, levels of oestrogen, or less commonly, hormone replacement therapy (HRT) [5]. 

Intrauterine devices (IUDs) 

IUDs are a popular form of contraception, but they can sometimes cause spotting or bleeding, especially shortly after insertion. If the bleeding is persistent or heavy, it might indicate that the IUD has shifted or that there is another issue that needs to be addressed by a healthcare provider [4]. 

Impact of lifestyle factors 

Certain lifestyle factors can contribute to the likelihood of experiencing bleeding after sex. Smoking, for example, has been linked to cervical changes and increased susceptibility to infections. High-stress levels can also affect hormonal balance, leading to irregular menstrual cycles and bleeding issues [6]. 

Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking, can improve overall reproductive health and reduce the risk of post-coital bleeding. Staying hydrated and using appropriate lubricants during intercourse can also help mitigate some of these issues [6]. 

When to see a doctor 

While occasional light bleeding after sex is often not a cause for concern, you should see a doctor if: 

• The bleeding is heavy or lasts for more than a couple of days. 
• You experience pain or discomfort during or after sex. 
• There is an unusual discharge, odour, or other signs of infection. 
• You have not had a recent cervical screening or are due for one. 

Seeking medical advice is crucial if you experience persistent or severe symptoms. A healthcare provider will conduct the necessary tests to determine the underlying cause and recommend appropriate treatment. Here are some common treatment options: 

• Moisturisers and lubricants: For vaginal dryness and irritation, using moisturisers and lubricants can help reduce friction and prevent bleeding. 
• Antibiotics: For infections such as bacterial vaginosis, yeast infections, or sexually transmitted infections (STIs) like chlamydia or gonorrhoea, antibiotics are used to treat the infection. 
• Therapy: For hormonal imbalances, therapy including low oestrogen levels (creams, rings, etc.) can help manage symptoms. 
• Medication for viral infections: For viral infections, medication is used to treat the infection. 
• Chemotherapy, radiation, or surgery: For cancer of the cervix, these treatments are used to manage the condition. 
• Removal of polyps: For cervical polyps, surgical removal is often necessary. 
• Discontinuing hormonal contraceptives: For cervical ectropion, discontinuing hormonal contraceptives may help resolve the condition. 

• Kegel exercises: For uterine prolapse, Kegel exercises can help strengthen pelvic muscles and alleviate symptoms. 
• Surgical repair: For severe uterine prolapse, surgical repair may be necessary [3]. 

Home remedies and preventative tips 

If you're experiencing bleeding after sex, here are some home remedies and preventative tips that might help: 

• Use lubrication: Ensuring adequate lubrication can help reduce friction and prevent minor injuries. 
• Be gentle: Avoiding rough or vigorous intercourse can help prevent tears and abrasions. 
• Stay hydrated: Keeping well-hydrated helps maintain healthy vaginal tissues. 
• Manage infections promptly: Seek medical treatment for any infections to prevent complications. 

Maintaining regular medical check-ups and screenings can help detect any issues early on and ensure timely intervention [2]. 

How HealthHero can help 

At HealthHero, we offer virtual consultations with experienced clinicians who can help diagnose and treat conditions causing post-coital bleeding. Access fast and secure medical advice from the comfort of your home. For more information and support, visit our online consultations page.