Bleeding During or After Sex: Why Does It Happen?

If you’ve never experienced bleeding from sex, seeing it for the first time can be alarming. Typically, if you haven’t hit menopause, encountering light bleeding on rare occasions after sex is completely normal. However, some instances of postcoital bleeding may require medical attention.

What is postcoital bleeding?

Postcoital bleeding is bleeding or spotting during or after having sex that isn’t due to menstruation. This spotting or bleeding can occur for various reasons. Postcoital bleeding can last one to two days after your last sexual encounter. This condition is common among people who don’t menstruate or have ovarian-related conditions.

Potential causes of postcoital bleeding:

Here are nine reasons why bleeding during or after sex happens.

1. Menstruation

If you have a menstrual cycle, you can experience some bleeding during or after having sex. You may notice spotting or bleeding after sex at the start or end of your period. Postcoital bleeding is usually expected if you are menstruating.

2. Pregnancy

Having sex while pregnant can lead to bleeding. This can occur because the cervix is more sensitive during pregnancy, causing an increase in the blood flow to the cervix. People who are expecting may experience red or brown spotting after sex.

In addition, there are other causes of bleeding during or after sex while pregnant, which can include:

• Implantation. Implantation bleeding is light bleeding that can occur within 10 to 14 days after conceiving a baby, when the fertilized egg implants into the uterus's wall. Having sex can cause vaginal and seminal fluids to pass implantation blood into the vagina.
• Placenta previa. A health condition in which the placenta during a pregnancy completely or partially covers the uterus’s opening. Thus during pregnancy, sex can cause bleeding from the placenta previa.
• Placental abruption. Happens when the placenta separates from the uterus’s inner walls before birth. Spotting may occur from blood being released by intercourse. This is usually accompanied by severe abdominal pain, is a medical emergency and you should seek help urgently.
• Ectopic pregnancy. An ectopic pregnancy occurs when the fertilized egg grows outside the uterus, such as in the fallopian tube or ovary. In rare instances, this condition may cause bleeding after sex. It is important to seek care early if you suspect you have an ectopic pregnancy, since it may grow and burst the tube or other organ it has implanted in.
• Miscarriage. Heavy bleeding during sex can indicate a possible miscarriage.
• Early labor. One sign of early labor is bloody show. A bloody show describes the process of the body preparing for labor. Having sex can trigger a bloody show due to the cervix being thinner and more sensitive closer to labor.

3. Vaginal cuts and tears

Vaginal cuts and tears are common occurrences that can arise from childbirth, removing body hair, or having sex. During sex, vaginal dryness can increase friction due to a lack of natural or artificial lubrication. With vaginal dryness, people with vaginas have an increased risk of developing vaginal cuts and tears that can cause bleeding.

Aside from vaginal dryness, vaginal cuts and tears can occur from:

• Lack of arousal
• Rough sex
• Menopause
• Sharp nails

4. Uterine and cervical polyps

Uterine polyps, or endometrial polyps, are growths attached to the inner walls of the uterus. This condition is common among people who are going through or who have completed menopause. In certain instances, sexual intercourse may burst the uterine polyps, causing bleeding during and after sex.

Like uterine polyps, cervical polyps are benign or noncancerous growths on the cervical canal. However, during sex, the polyps may become detached from the cervix, potentially leading to bleeding.

5. Menopause

As mentioned, menopause can cause vaginal dryness, leading to vaginal cuts and tears that can cause bleeding. Menopause is a time that marks the end of the menstrual cycle, typically between ages 45-55. The condition is diagnosed after going 12 months without a menstrual period.

6. Reproductive health conditions

Certain reproductive health conditions, like pelvic inflammatory disease (PID) and endometriosis, can cause postcoital bleeding. People with PID may experience unusual vaginal bleeding during or after sex. With endometriosis, the uterine tissue can become irritated and tender from penetration, leading to bleeding during and after sex.

7. Sexually transmitted infections (STIs)

Vaginal bleeding is a symptom of several sexually transmitted infections (STIs). Herpes, chlamydia, and gonorrhea are STIs shown to cause vaginal bleeding among patients. In addition, having sex with an STI can lead to bleeding during or after sex.

8. Cervical ectropion

With cervical ectropion, the cells lining the inside of the cervix begin to grow on the outside of the cervix. This condition is harmless and does not indicate cervical cancer, though it can cause light bleeding, discharge, or pain during and after sex.

9. Certain cancers

All gynecologic cancers except for vulvar cancer can cause abnormal vaginal bleeding or discharge. People with cervical, ovarian, uterine, or vaginal cancer can experience postcoital bleeding.

How to prevent or reduce bleeding during sex

Although it’s not uncommon to experience bleeding from sex, some may feel concerned about its occurrence. As mentioned, postcoital bleeding is rarer among people who are still menstruating, so there may be some cause for worry when they notice bleeding or spotting.

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Fortunately, there are preventive methods for preventing or limiting postcoital bleeding. Here are some ways to avoid or limit bleeding during or after sex.

• Have foreplay. Spend more time on foreplay to increase arousal and natural lubrication in the vagina. On average people with vaginas require 15-20 minutes of foreplay to become fully aroused.
• Get tested for STIs. Testing for STIs is crucial to limit the chances of developing an STI and postcoital bleeding. Some STIs, such as HIV, can develop 6 months after exposure, so get tested regularly. If you are diagnosed with an STI, contact your partner(s) about the possible exposure and recommend they get tested too.
• Use lubricant. Try lubricants to prevent friction and bleeding during sex.
• Receive treatment for polyps. Speak with your doctor to see if removing the polyps would be a safe option for preventing vaginal bleeding.
• Wait until your period is over to have sex. If possible, wait until your menstrual cycle has ended before engaging in sexual intercourse to avoid bleeding or spotting.
• Communicate with your partner(s). Keep an open line of communication between you and your partner(s), so they can be aware if you start experiencing pain or bleeding during sex.

When to seek medical care

If you begin to experience postcoital bleeding that is severe, recurring, or lasts longer than a day or two after having sex, please visit your healthcare provider. Also, if you have symptoms like burning, itching, abnormal discharge, and pelvic pain alongside bleeding, it’s important to share those details with your doctor.

Your doctor may recommend the following tests to determine the cause of your bleeding is, such as:

• Pregnancy test
• Pelvic examination
• Examining the cervix with a speculum

You may be referred to a gynecologist for further testing and diagnosis for your vaginal bleeding.

In many cases, bleeding during or after sex, known as postcoital bleeding, is normal to experience. However, there are some cases in which people with vaginas may experience unusual bleeding that occurs outside of menstruation or pregnancy.

There are several reasons why postcoital bleeding can occur, ranging from menopause to ectopic pregnancy. A doctor can run different tests to determine the cause of the bleeding.