When you have sex for the first time, it’s normal to expect some bleeding right away or even for a couple of days afterward. But if your first sexual experience is long past and you notice bleeding after sex, you should have it checked out.
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Most of the time, it’s nothing major, but bleeding after sex can sometimes signal a larger problem. Even if you only notice light spotting, it’s a good idea to see your doctor.
Ob-Gyn Lynn Simpson, MD, says there are several things that might cause bleeding after you have sex. While some go away without treatment, medication or a minor procedure can resolve other problems. Your doctor can help you determine the cause and treatment, if needed.
8 things that can cause bleeding after sex
1. Menstruation: This may seem obvious, but before you call your doctor, consider whether it’s around that time of the month. “If you have sex right before or after your period, that may explain your bleeding,” says Dr. Simpson. Keeping track of your cycles is helpful for resolving such questions. There are several apps available that can help you keep track of your period cycles.
2. Vaginal atrophy or dryness: This typically relates to a lack of estrogen (and often shows up after menopause). “If dryness is severe, the friction of intercourse may cause bleeding,” Dr. Simpson explains.
Treatment: Using lubrication during sex may help. If estrogen is the issue, your doctor may recommend hormone replacement therapy in pill, insert or cream form.
3. Cervicitis: This is an inflammation or infection of the cervix. It may cause bleeding or a change in your vaginal discharge.
Possible causes include:
- Sexually transmitted diseases, such as chlamydia.
- Bacterial vaginosis, or an imbalance of the naturally occurring bacteria in the vagina. While this isn’t a likely cause, sometimes secondary inflammation can cause bleeding after sex.
- Trichomoniasis, or a sexually transmitted infection from a parasite.
Treatment: Your doctor will prescribe an antibiotic.
4. Cervical ectropion: Soft, glandular cells that line the inside the cervical canal expand into the outer part of the cervix (where the cells are typically harder).
Treatment: This is normal for many women (and would not require treatment), but if there are symptoms, such as excessive discharge or bleeding, it could require treatment.
“If you have bleeding or pain from cervical ectropion that interferes with your sex life, your doctor may recommend treatment,” says Dr. Simpson. During this outpatient procedure, your doctor will use heat or cold therapy to treat the area and stop the bleeding.
5. Cervical polyps: These are growths on the opening of the cervix that sometimes result from chronic inflammation or hormonal changes.
Treatment: Almost all cervical polyps are benign. If your symptoms are minor, you may not need treatment. When they are removed, it is because of a small chance of abnormal cells in association with irregular bleeding. All removed polyps are sent for evaluation to make sure the cells are normal.
6. Uterine prolapse: If your uterus comes out of its normal position, your cervix and other tissues are sometimes exposed. If the condition is severe enough, it may cause bleeding.
Treatment: For minor prolapse, your doctor may recommend weight loss or kegel exercises to strengthen muscles in the area. In more severe cases, your doctor can insert a ring to support the tissue or perform surgery to repair it.
7. Lesions: Lesions found in the cervix are often benign. But they may bleed after you have intercourse.
Treatment: Your doctor may do further testing to get a closer look and determine if they are cancerous. A procedure can remove lesions with either a laser or freezing technique.
8. Cervical cancer: About 11% of women who have cervical cancer have post-coital bleeding. It is often the first symptom of cancer.
Treatment: If cervical cancer is diagnosed, your doctor will refer you to a gynecologic oncologist for further management. For pre-cancerous cells, a simple outpatient treatment can remove abnormal cells. If the cells are cancerous, your doctor likely will recommend chemotherapy, radiation or surgery.
When should you see your doctor?
A good rule of thumb is that any abnormal bleeding, whether it is just a few drops or a large amount, needs to be evaluated, Dr. Simpson says.
“If you are having something that isn’t normal, your uterus is talking to you and saying something isn’t right,” she says. “It’s not necessarily bad, but if it is recurrent or you are just concerned, get it checked out.”
What can you expect during your doctor visit?
Your doctor will take a health history and ask about:
- Other irregular bleeding.
- Heavy or irregular periods.
- Unusual pain that doesn’t seem to relate to the bleeding.
- A change in sexual partners.
- A change in vaginal discharge.
- When you had your last Pap test.
A physical exam will check for signs of infection.
If your Pap test isn’t current, your doctor will be sure to perform one for you while you’re in their office. A Pap screening can help determine the need for any further tests or procedures.
If your testing shows no problems, but your bleeding continues — and it only occurs after sex — your doctor will likely want to check your cervix and do a biopsy. This may show any underlying condition that a physical exam and Pap smear did not find.
“The important thing to remember is that most of the time it is nothing bad and goes away on its own,” Dr. Simpson says. “But it’s sometimes a sign of a serious underlying condition that needs attention.”
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