Vaginal bleeding following sexual intercourse can be a scary experience and at times there is reason for concern. Bleeding after intercourse, also referred to as postcoital bleeding, describes vaginal bleeding or spotting experienced during or after sex which is not related to your menstrual period. Postcoital bleeding also refers to bleeding from other genital areas, as well as the urinary system. It is important to note that bleeding can be caused by varied physical conditions.

Premenopausal women who experience postcoital bleeding generally experience the bleeding from their cervix, which can be caused by friction/trauma during sex. However, this kind of bleeding can also signify the presence of a sexually transmitted disease. Postmenopausal women (women who no longer get their menstrual periods) may also experience postcoital vaginal bleeding which my come from the urethral meatus, the labia, uterus and/or cervix.

While there are several causes of postcoital bleeding, it should be noted that some are serious and some less concerning. The most concerning cause of postcoital bleeding is cancer, evidenced by 11% of women with cervical cancer presenting to their healthcare provider with postcoital bleeding.

Other causes of postcoital vaginal bleeding include the presence of non-cancerous conditions such as:

• Cervical ectropian
• Benign cervical growths referred to as cervical polyps
• Inflammation of the cervix referred to as cervicitis
• Genital sores related to sexually transmitted diseases such as the presence of herpes or syphilis
• Decreased vaginal lubrication
• Uterine lining injury, especially present in women who are on oral contraceptives
• Menses
• Trauma (related to sexual abuse)
• Vaginal atrophy, dryness or vaginitis
• Other sexually transmitted diseases
• Prolapse of the genital organs
• Lesions of the vagina and/or lining of the uterus

If you are experiencing postcoital bleeding, you should speak with your healthcare provider to determine if you are in need of an evaluation based on your individual circumstances. If you have been recently exposed to a sexually transmitted disease or have concern that you may be experiencing an infection, you should speak with your healthcare provider for an evaluation. In most cases, premenopausal women who bleed infrequently after intercourse and who have normal Pap Smear and sexually transmitted disease screenings will not require an evaluation however if the bleeding is concerning to you, it may benefit you to speak with your healthcare provider for guidance. Postmenopausal women who experience any vaginal bleeding at any time should be evaluated regardless of the likely cause.

During evaluation, your healthcare provider may utilize varying approaches to further evaluate the bleeding and may include:

• History and physical exam, including an exam of the vagina and cervix
• Sexually transmitted disease testing
• Biopsy of any abnormal findings
• Colposcopy
• Evaluation of the uterine lining

If you are experiencing postcoital vaginal bleeding, speak with your healthcare provider to determine your individual need for evaluation.

Sources:

1. Shapley, M. Post Coital Bleeding in Women. Up to Date. 
2. Vaginal Bleeding After Sex. Mayo Clinic.