10 Reasons You Bleed After Sex, According to Doctors
Experts explain exactly why you might experience this all-too-common symptom.
There's no denying that bleeding after sex can put you in a panic. Whether it's your first sexual experience or you've been at it for a while, the sight of blood is never welcome. And while abnormal bleeding is something you'll always want to discuss with your doctor, it's not always a sign that something is seriously amiss. In fact, as many as nine percent of sexually active women will experience post-sex bleeding at some point, according to a 2014 study published in the journal Obstetrics and Gynecology International.
To help you get to the bottom of your symptoms, we asked the experts about the most common causes of bleeding after sex and bleeding during sex. From vaginal dryness and cervical polyps to sexually transmitted infections and harsh feminine hygiene products, these are the most common causes of bleeding during sex.
1. It's your first sexual experience.
"Bleeding after sexual activity for the first time is normal," says Dr. Janette Nesheiwat, MD, a family and emergency medicine doctor. This is caused by the breaking of a thin layer of tissue called the hymen, she explains, which covers part of the entrance to the vagina. Once it breaks, it can result in bleeding, which is completely normal, she adds.
2. Vaginal dryness is causing tears.
Dryness may be another culprit behind your bleeding woes, says Dr. Monique May, MD, board-certified family physician. "If the vagina is dry, there can be some damage and tearing of the area during penetration," she says. "Engaging in adequate foreplay and using personal lubricants can help prevent this from occurring."
Dr. May explains that some women are predisposed to vaginal dryness, especially those experiencing menopause or those on certain birth controls. That means you'll want to consult your physician if this is a concern.
3. You're bleeding from rough sex.
Similarly, a rough romp in the sack could also lead to tears in the vagina, which may lead to bleeding. "Some women may bleed due to sex causing tears in the vagina," says Dr. Dione Occenad, MD, FACOG. This can occur during rough sex or during sex with a well-endowed partner, she says.
And although more lubrication and communicating with your partner can help mitigate this issue, there are other ways to help bounce back after these kinds of sexual encounters, according to Dr. Nesheiwat. "Taking a cool shower, wearing a pad only, and staying hydrated are all helpful measures one can take after any sexual act," she explains. However, she also stresses the importance of scheduling a visit with your gynecologist if you're worried there's an issue.
4. You have a sexually transmitted disease.
"Bleeding can also be caused by sexually transmitted infections (STIs) that affect the cervix such as gonorrhea and chlamydia," says Dr. May. "This may be the only symptom a woman has of these curable diseases, so seeing a doctor at the first sign is very important."
Chlamydia and gonorrhea are most often associated with bleeding after sex because they lead to inflammation of the cervix. Other symptoms to be aware of are abnormal vaginal discharge, painful periods, abdominal pain, and itching or burning in and around the vagina.
5. You have polyps on your cervix.
A woman who finds herself bleeding during sex may also have polyps on her cervix, says Dr. May. "Polyps are fleshy growths that can be caused by an abnormal response to estrogen or from inflammation," she explains. "They are not the same as warts, and very rarely do they become cancerous, but they can bleed from penetration during sex when the penis (or sex toy) pushes up against them."
And while Dr. May stresses that vaginal polyps are usually non-cancerous, she notes that they can, in some cases, be caused by certain strains of HPV (human papillomavirus). This may lead to an increased risk for developing cervical cancer, she warns. Again, see your doctor ASAP if you notice something is amiss.
6. You're experiencing menopause.
"Menopausal women may experience bleeding after sex due to the thinning of the vaginal tissue," says Dr. May.
This is often caused by low levels of estrogen as a result of menopause, she notes. The vaginal tissue can atrophy and become thin and less elastic. Again, adequate foreplay and personal lubricants can be helpful, she recommends.
7. You've got eczema or dermatitis.
Any condition that irritates and inflames the local skin can cause bleeding, Dr. May suggests, so if a woman has certain rashes, such as eczema or dermatitis, in her genital area these may play a huge role as well.
If you aren't sure what kind of warning signs to look for, Dr. May suggests that both eczema or dermatitis can cause itchy and scaly rashes in the genitalia and elsewhere in the body. So, if this is something you are dealing with, she says it's always wise to share your concerns with your physician or dermatologist.
8. Your period just started.
"A woman's period may coincidentally start while she is having sex," Dr. May explains. This is perfectly natural, she adds, and is usually not caused by the sexual act itself.
9. You have cervical ectropion.
Some women may have cervical ectropion, according to Dr. Occenad. This is where the cells that are normally found inside the cervix are also exposed on the outside of the cervix, she explains. These are called glandular cells and they are very delicate and are easily irritated as well, she adds.
Dr. Occenad also notes that these cells differ from the cells normally found on the outside of the cervix, which are called squamous cells, and are usually very resilient. However, during intercourse, these cells are easily damaged and can cause bleeding. Dr. Occenad notes that cervical ectropion is a condition that is normally harmless and is typically seen with women on birth control or during pregnancy, she adds.
"Cervical ectropion is usually caused by increased estrogen as is the case in pregnancy, and with women on birth control," she says. "This condition will usually resolve after pregnancy or with modifications in birth control, and rarely does it need to be treated." However, there are treatments available if the condition does not clear up on its own.
10. You have lichen planus or lichen sclerosus
"Other causes of tears at the vaginal opening [can come about] from a vulvar skin condition such as lichen sclerosus or lichen planus, says Dr. Felice Gersh, MD, OB/GYN, founder and director of the Integrative Medical Group in Irvine, California.
However, Dr. Gersh explains that it's important to note that lichen sclerosus and lichen planus are two entirely different conditions, despite the fact that their names sound pretty similar.
Lichen sclerosus is thought to be an autoimmune condition that results in a severe thinning of the skin. It occasionally appears with white patches on the vulva (and may cause significant itching and discomfort), although many women with lichen sclerosis have no abnormal sensations whatsoever.
Lichen planus is also an autoimmune disease of the skin, but it is more of an erosive skin condition in comparison. "The labial/vulvar skin becomes severely erythematous (red) and can be raw, weepy, and painful," she explains. "This type of skin disease can result in bleeding with sexual relationships due to friction and irritation," she adds.
What to do if you experience bleeding after sex
"Bleeding after sex is never normal, except when having sex on one's period," Dr. Gersh explains. This usually requires a gynecologist visit and examination, she adds, and possibly a pelvic ultrasound (abdominal and vaginal probes to be used). In the meantime, avoid using tampons and cleansers, which can irritate the area.
And of course, make sure you're visiting your gynecologist on the regular to stay ahead of any symptoms. "Sometimes the first symptom a woman has of cervical cancer is pain and bleeding during sex, so getting pap smears (a test that can detect abnormal cells in the cervix before they become cancerous) at the recommended intervals is very important," Dr. May advises.
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