Sex & Love

So you just had a nice romp in the sack and now, you’re dutifully peeing to avoid a UTI. (Great job, by the way.) But as you’re wiping, you see blood. What does that mean?

Before you panic and text all of your friends for help, take a few deep breaths. Bleeding during or after sex, while jarring in the moment, isn’t necessarily a cause for concern, especially if there isn’t a ton of blood.

“It’s not an uncommon thing that we [as doctors] hear about,” says Dr Lyndsey Harper, a board-certified ob-gyn and founder of sexual wellness app Rosy. “And the reason for that is because it can happen in so many different scenarios.”

In many cases, bleeding during or after sex could be due to menstruation, or a microtear in the vagina. And the good news is, even if there’s a more serious reason (like a larger tear, or an STI), it’s likely treatable. Still, you’ll want to schedule a visit to your gynaecologist if the bleeding is heavy, bright red, or accompanied by pain—and, most importantly, if it happens more than twice in a brief window of time, says Dr Harper.

Meet the Experts:

Want to learn more? No need to crowdsource from your group chat: Women’s Health rounded up all the info you need about the common causes of bleeding during or after sex, including how to treat it and when to check in with your doc about it.

What are some common reasons for bleeding after sex?

There are many reasons you might experience bleeding during or after sex, so it’s always a good idea to talk to a doctor if you’re concerned. But here are some of the most common explanations, per ob-gyns.

1. You’re on (or you just finished) your period.

This is one of the most common reasons—and also one of the least worrisome, says Dr Harper.

If your period recently ended, or it’s about to begin, you might see blood that’s slightly darker and browner in colour. “You can’t count on this a hundred percent of the time, but most of the time, if [the bleeding] is related to your period, the blood is going to be a dark brown,” she explains.

2. You tore your hymen.

You might have heard the myth that your hymen “breaks” after your first time having sex. The truth: It’s a little less one-size-fits-all than that. While many people do have a hymen, or tissue around their vagina, it doesn’t necessarily tear the first time you have intercourse, says Dr Harper. Sometimes, it can tear at an earlier age, due to tampon usage or certain kinds of exercise. And sometimes, a person can even have penetrative sex several times before their hymen tears, Dr Harper explains.

If this happens to you, you’ll notice a distinct bright red colour. You’ll also probably feel a very brief, “sharp” moment of discomfort that’s more shocking than it is painful, says Dr. Harper.

3. You’re experiencing vaginal dryness.

There are many factors that can cause vaginal dryness, including birth control, breastfeeding, or menopause. “Vaginal dryness can lead to thinning of the vaginal wall and increased friction during intercourse. That can create little tears, which can bleed,” says Dr Harper.

The words “vaginal tearing” might make you wince, but this is another very common cause of postcoital bleeding. Your best bet: Loading up on lube in preparation for sex, says Dr Brandye Wilson-Manigat, a board-certified ob-gyn and sex coach. She recommends adding a high-quality water-based or silicone-based lubricant into your sexual routine.

If you’re going through menopause and having a persistent issue with bleeding, though, Dr Harper suggests setting up an appointment with your gynaecologist, who might recommend a hormone replacement. “Lack of oestrogen during menopause can lead to lots of other issues in addition to vaginal bleeding, so it’s always worth a discussion with your healthcare provider,” she explains.

4. You just had sex that was a bit rougher than usual.

Another reason you might have some vaginal tearing? Rough sex, or a larger-than-usual penis or strap-on, explains Dr Wilson-Mangiat. Slight tearing could be more likely if you haven’t had sex or been penetrated at all recently, adds Dr Nicole Williams, an ob-gyn at the Gynecology Institute of Chicago. “If it’s been a while since you’ve had sex, the tender skin around the vagina may have a microtear and cause some spotting,” says Dr Williams.

In many instances, these tears are small and can heal on their own, assures Dr Harper. If you’re spotting slightly or the bleeding stops, it might just be a sign to tread more carefully (and with more lube) next time. But if the bleeding is heavy and insistent, you may have a larger tear that requires medical treatment.

“You might notice [a bit of blood] on your toilet paper and think, ‘Oh, let me keep on eye on this.’ But if it’s a large tear, you’re going to be bleeding heavily, it’s going to be bright red blood and you’re going to need attention to make it stop,” she explains.

5. You have a skin condition that makes you susceptible to tearing or bleeding.

In some cases, the light bleeding could be a result of a skin condition that caused tearing. For example, a medical skin condition called lichen sclerosus, which can contribute to irritation and itching of the vulva in the prepubescent stage and after menopause, is also a source of tearing or bleeding after sex, Dr Wilson-Manigat explains.

6. You have cervical polyps.

Cervical polyps are one of the more common reasons for bleeding during sex that Dr Wilson-Manigat has seen in her practice. “These are benign growths on the cervix that are similar to a skin tag you would see on another area of your body,” she says. “But the difference between a skin tag and a polyp is that polyps can bleed very easily with light touch, which is why you may have bleeding from them during sexual activity.”

Most of the time, they can be found during your routine pelvic exam and pap smear. Dr Harper stresses that they aren’t cancerous, but should still be addressed by a gynaecologist, so set up an appointment with your doc if you think you might be prone to polyps.

7. You’re pregnant.

Before you’ve even taken a test, light bleeding could be your first clue that you’re pregnant. One of the initial signs of early pregnancy can be vaginal bleeding, also known as implantation bleeding, which can occur right after sex, says Dr Alexandra Bausic, a board-certified gynaecologist and sex educator at Let’s Talk Sex. The cause of bleeding is the implantation of the embryo inside your uterus, so it may show up at any time, unrelated to penetration, Dr Bausic notes.

If you think there’s a chance you could be pregnant and you’re noticing bleeding during sex or in general, take a test and then give your gyno a call. And if you’re further along in your pregnancy, bleeding during or after sex isn’t a totally abnormal occurrence—but you should also let your doctor know, just so they can make sure everything’s okay, Dr Harper suggests.

“There are causes for bleeding during pregnancy that are not a big deal and then there are causes for bleeding during pregnancy that are a really big deal,” she says. “If the placenta is over the cervix, if you’re going into pre-term labour… There are a lot of things we want to rule out before we say, ‘eh, not a big deal.’”

8. You have cervicitis.

Another one of the more common explanations for bleeding during or after sex is cervicitis. While the word may sound scary, what’s basically happening is an inflammation of the cervix, says Williams.

In some cases, a common infection such as bacterial vaginosis (BV) or an allergic reaction to latex condoms or certain feminine hygiene products causes inflammation in the cervix, according to the Mayo Clinic. But cervicitis can be easily treated with a topical antibiotic, Dr. Williams says.

9. You have an STI.

If you’ve been experiencing other symptoms down there—including difficulty peeing, discharge that smells more odorous than usual, or discharge that appears to be green or yellow in colour—you might have an STI, says Harper. “Gonorrhea and chlamydia can infect the cervix and make it fragile, so irritation to the cervix can make it bleed more readily,” she explains.

Luckily, gonorrhoea and chlamydia are both treatable—just set up an appointment with your doctor, who can run some tests and help you get treatment. In more rare cases, an HPV infection could be causing some type of cervical pre-cancer, but don’t panic: Your doctor will flag any abnormalities with your pap smear first.

10. You have a yeast infection.

A sexually transmitted infection may not always be the cause—yeast infections can also be to blame for vaginal bleeding, says Dr Alyssa Dweck, an ob-gyn and author of The Complete A To Z For Your V. When you have a yeast infection, your vagina becomes sensitive, swollen and inflamed, which can lead to bleeding when you wipe, have sex, or itch the area, Dr. Harper adds.

Chances are, if you have a yeast infection, other symptoms—namely, painful vaginal itching and clumpy, adherent discharge—will present themselves first, explains Dr. Harper.

11. You have cervical cancer.

Unfortunately, there is a worst-case possibility: “Pre-cancerous and cancerous cells of the cervix can definitely cause bleeding and that is obviously very worrisome,” says Dr Harper. What’s also concerning is that, oftentimes, cervical cancer—especially in its early stages—presents very few symptoms. This is why she always recommends seeing a doctor if the bleeding starts happening semi-frequently, even if just to rule it out.

With cervical cancer, “you can have spotting with intercourse, but you can also have some random spotting, too,” Dr Harper explains. “And it’s bright red, not like menstrual spotting. Whenever people are having bright red bleeding outside of their cycle, they want to be evaluated.”

So I should really see a doc if I bleed during or after sex?

Definitely, if it’s a recurring thing. Here’s Dr Williams’ rule of thumb: “If you have a single episode of bleeding after sex, especially if you’re just finishing your period or have started a new hormonal birth control, it may not be anything to be concerned about. However, if it happens more than once, it’s best to just make a quick visit to the gyno and have yourself checked out.”

After you’ve made your doctor appointment, come prepared with as much information as possible to help ID your condition. First, always pay attention to the colour of the blood. “Darker blood is usually older blood and is not as concerning as if it were very bright red,” Dr Williams says. Also, take note if the blood is accompanied by pelvic pain and discomfort. Or, if your vaginal discharge has a different texture or smell, advises Dr Bausic.

In terms of treatment, rest assured that many of these conditions are treatable once your doctor is able to diagnose you with the infection or skin condition. One way to rule out infections before you’re even in the doctor’s office is by making sure that pregnancy or any kind of potentially irritating external products aren’t causing the bleeding, Dweck says.

For many one-time occurrences of bleeding during sex, using lube the next time around can do the trick. But if that’s not helping, it’s best to look further into what could be causing the bleeding. It’s true that sex can be messy—and while talking about bodily fluids and blood can sometimes be uncomfortable, your gyno is trained to help you. That way, you can make sure sex gets back to what it should be: fun!

This article was first published in womenshealthmag.com More