What Causes Post Coital Bleeding?
Dr. Renuka Dangare

Dr. Renuka Dangare

Apr 20Sexual health

What Causes Post Coital Bleeding?

Vaginal bleeding after sex is known as post-coital bleeding in medical terms.As per a common belief that most women might experience vaginal bleeding or spotting either during or after sex, at least once in their life.

Research says that nearly 9 percent of menstruating women will experience vaginal bleeding after sex, regardless of their period-cycle. 

While postcoital bleeding occurs in people of all ages, the source of the bleeding amongst women who haven't experienced menopause is the cervix. In the case of women who’ve had menopause, the source of the bleeding could be:

  • Uterus
  • Urethra
  • Labia
  • Cervix

While most of these causes of bleeding are usually common and easily treatable, there could be a reason to worry too.

Post Coital Bleeding

Let us look at some of the causes of bleeding after sex:

1. Vaginal Dryness

Dryness or reduced lubrication in your vagina may be a cause of spotting after penetrative sex. The dryness can be as a result of increased friction either due to inadequate foreplay or due to inadequate lubrication as a result of some other condition in your body. An increase in the concentration of the hormone progesterone can cause vaginal dryness. Some of the conditions where we are likely to see it are -

a)   Postpartum - right after you’ve given birth, especially within the first 6 - 12 weeks

b) When breastfeeding (Even after the first 12 weeks of postpartum)

c) Some medications such as antidepressants, anti-estrogen drugs, etc. 

Dryness can also occur with a drop in the levels of our reproductive hormones and is a natural occurrence with -

  1. menopause
  2. removal of ovaries

If the natural bacterial symbiosis of the vagina is disturbed, then lubrication is likely to get affected too. Practices such as douching and reactions caused by chemicals in various health and hygiene products which women use, like, razors or laundry detergents can also cause vaginal dryness and in turn, friction and spotting after sex.

Sjögren’s syndrome, an inflammatory disease that affects the immune system by reducing moisture generated by glands in the body, affects vaginal lubrication too.

2. Genitourinary Syndrome of menopause

Genitourinary Syndrome of menopause or GSM was formerly known as vaginal atrophy. The condition is common in women who are in perimenopause and menopause and those who’ve had their ovaries removed surgically prior to menopause.

Aging and menopause cause your body to produce lesser amounts of estrogen, the hormone which is responsible for regulating your reproductive system. Lower estrogen levels lead to lesser production of vaginal lubrication. As a consequence, women can feel irritation or dryness in the vagina. Lower estrogen levels also reduce the elasticity of the vagina. When the elasticity decreases, vaginal tissues become more fragile and get less blood flow. Hence, they are more prone to tearing and irritation, leading to discomfort, pain, and bleeding during sex.

3. Polyps 

Polyps could be another reason for women to experience spotting or bleeidng after sex.. Polyps are noncancerous growths, found on the cervix or in the endometrial lining of the uterus. Polyp movement can irritate the surrounding tissue leading to bleeding from small blood vessels.

In this case, the menstruator is unlikely to notice any symptoms. A visit to your gynecologist's office and a pelvic exam will confirm the presence of the polyp. In those experiencing frequent bleeding or with infected polyps, doctors may recommend additional treatment.

4. Endometriosis 

Endometriosis occurs when the endometrium or the lining of the uterus extends outside of the uterus. In such a case, the endometrial tissue attaches itself to the surfaces of other organs, leading to severe pain and, in some cases, infertility.

The identifiable symptoms of endometriosis are painful intercourse, particularly on deep thrusting and painful orgasms in some cases. They are caused by the added strain and pressure on the tissues which are already vulnerable. 

5. Cervical ectropion

Cervical ectropion is a condition where the cells that are placed on the inside of the cervix protrude outside through the opening of the cervix or cervical os. This leads to bleeding while having sex or using tampons, etc when the cells come in contact with outside substances. Cervical ectropion can occur in adolescents, women taking birth control pills, and pregnant women whose cervixes are more sensitive than normal. 

You may not experience any symptoms apart from bleeding or spotting after sex and this condition is very likely to be spotted in a pelvic exam at your gyanec’s clinic or on a PAP smear . There is nothing to worry about, if the ectropion is not bothering you significantly, doctors will advise you to leave it alone.

6. Trauma

Bleeding can also result from direct trauma to the vulva, vagina or cervix. . Aggressive sex can lead to cuts, scrapes, or tears on the vagina.

Forced or non-consensual entry (as in case of sexual abuse, etc.) can damage vaginal tissues and lead to the formation of fissures, which can recurrently heal and reopen unless medically treated.

7. Infection

Bleeding after sex may also be as a result of infections in the vagina, cervix or uterus.

Vaginal infections may usually also cause increased vaginal discharge and itching. Cervical and uterine infections can cause spotting at times other than after sex. Some STI’s such as chlamydia and gonorrhoea can cause post coital bleeding and no other symptoms at all. Fever, foul smelling vaginal discharge, belly pain and pain during sex are also some other symptoms indicating that this could be an infection.

The best way to confirm is by a direct examination. If you have had unprotected sex with a partner who’s STI test status is unknown or if there is any reason for your doctor to suspect an STI, getting some tests done will help.

8. Cancer

One of the more serious concerns following bleeding after sex is cervical cancer and in rare cases, cancer of the vagina. Tumors can vary depending on the type of cancer involved. As the tumor grows, the network of blood vessels can become strained and prone to bursting. Sexual intercourse can sometimes cause this. Bleeding during cancer might include:

a) Bleeding after menopause or during the menstrual cycle

b) Vaginal discharge with a minor quantity of blood 

c) Heavy or longer-than-usual periods

How serious is postcoital bleeding?

Minor bleeding every once in a while, isn’t serious. But seeking a doctor’s advice or going for a physical exam is always advisable.

When to see a doctor?

You should seek your doctor’s advice if you have any of the following symptoms apart from unexplained vaginal bleeding :

  • A burning sensation when urinating
  • Heavy bleeding
  • Unbearable  pain in your lower belly
  • Painful sex / Pain on deep thrusting during penetrative vaginal sex
  • Vaginal itching, increased discharge or irritation
  • Lower back pain
  • Nausea or vomiting

If you are over 45 or menopausal, make this a higher priority

How is post-coital bleeding diagnosed?

The gynaecologist may ask you some questions pertaining to your menstrual, sexual and contraceptive history to find out the causes of postcoital bleeding.

Tests and procedures

There are some common tests and procedures that your doctor may also ask for, such as the following:

  • A gynecological (vaginal & pelvic ) examination, including PAP smear test, to find the causes of bleeding in your vagina or cervix. 
  • A urine sample to check for pregnancy or any kind of urine infection.

  • An ultrasound scan, especially if your pregnancy test is positive, can help in figuring out if there is a problem with your uterus or ovaries, you are over 45 years old or if there is a family history of certain types of cancer.

How to prevent postcoital bleeding?

Certain lifestyle changes can greatly help lower your risk of bleeding after sex:

  • Use a lubricant before and during sex (Water-based or silicone-based lubricants help prevent bleeding caused by vaginal dryness and friction during sex.)
  • Consult the doctor for the removal of any cervical polyps or treat cervical infections.
  • Have more foreplay before penetration
  • Try less aggressive sex
  • Wait for some time until your period ends to have sex again.
  • Take sex slowly and stop if you feel pain.

Bottom Line

Bleeding during or after sex can be caused by various reasons and can be cured with doctor’s advice and certain lifestyle changes. Many of the causes of postcoital bleeding, such as infections and polyps, are treatable. Occasional spotting after sex generally clears up on its own without medical care. If you’re postmenopausal, immediately visit your doctor about any postcoital bleeding. Remember, there’s absolutely no shame in speaking out about irregular bleeding and it’s a common occurrence in a woman's life.

Disclaimer: This information is educational and should not be construed as medical advice. Please consult your doctor before making any dietary changes or adding supplements.

Proactive For Her is a digital clinic for women, offering accessible, personalised, and confidential healthcare solutions. We offer out-patient care, diagnostic services and programs for various health concerns of Indian women, across their lifetime - from puberty to pregnancy to menopause.