Vaginal bleeding after sex is a worrisome issue affecting up to 9% of reproductive-age women. For those beyond their menopause, the prevalence is higher. Postcoital bleeding adversely affects women's quality of life and intimate relationships.
Is it normal to bleed after intercourse?
Although bleeding after sex does not always point to a medically concerning cause, it is still better to seek medical help when it occurs. A doctor needs a thorough evaluation to rule out serious underlying issues. Most of the time, no underlying disease is found and you could put your mind at ease.
What causes a woman to bleed after sex?
Postcoital bleeding can arise due to various conditions. Many of them are benign and should not cause alarm. In some instances, it could signal a more serious underlying problem. Mentioned below are frequently encountered causes.
Menstruation
Normal menstrual bleeding may mimic postcoital bleeding and cause a false alarm in ladies who have lost track of their cycles, or those whose cycles are irregular due to hormonal imbalances. However, for many women, the reason they bled would be obvious and not cause any concern. Keeping track of cycles with a menstrual calendar and abstaining from sex for a few days after the periods have ended is helpful in such cases.
Cervical ectropion
This a benign condition involving the cervix, wherein the internal lining of the cervical canal gets everted and exposed to the vaginal environment. It is harmless and commonly occurs in pregnancy, adolescence and while using birth control pills. It may present with excessive vaginal discharge and bleeding or spotting during sex.
Symptomatic cervical ectropion is usually treated with heat or cold therapy to destroy the out-of-place cervical cells. This cures the symptoms of the patient effectively.
Cervicitis
This is inflammation of the cervix, commonly caused by infections, including sexually transmitted ones. Rarely, it may occur secondary to chemical irritation from latex in condoms or spermicides. Patients with cervicitis usually have mucopurulent cervical discharge, with the cervix being friable and vulnerable to bleeding after sex.
Cervical infections must be promptly treated with appropriate antibiotics, otherwise it can involve the uterus and fallopian tubes. This can lead to complications like pelvic inflammatory disease, infertility, chronic pelvic pain and increased risk of ectopic pregnancy.
Cervical cancer
Cervical cancer is by far the most common genital tract cancer causing bleeding after sex. This is also the most concerning cause of postcoital bleeding. The frequency of cervical cancer in women with postcoital bleeding is 3.0 to 5.5%. Cervical cancer is commonly preceded by precancerous cervical lesions. Routine cervical screening helps in its early detection, making it a very preventable disease.
Once diagnosed with cervical cancer, your doctor may refer you for further evaluation by a gynaecological oncologist. The treatment may consist of radiotherapy, chemotherapy or surgery, depending upon the cancer stage.
Cervical or uterine polyps
These are overgrowths of the cervix or endometrium, the inner uterine lining. They protrude through the cervical canal into the vagina and are prone to bleeding during intercourse.
The treatment involves the removal of these overgrowths. Although most of these polyps turn out to be benign, it is better to send the tissue removed for evaluation.
Vaginal dryness
Vaginal dryness leads to friction during sex because of lack of lubrication. This injures the vaginal lining and spotting may ensue during and after sex. The condition is common in women around their menopausal age and after childbirth.
The use of vaginal lubricants during sex alleviates this problem. Longer-standing vaginal dryness associated with sexual dysfunction can be effectively treated with vaginal rejuvenation treatments like ThermiVa®. It’s a safe and effective non-surgical method to treat dryness, vaginal laxity, urinary incontinence and enhance the quality of orgasm.
Atrophic vaginitis
This condition affects women after menopause. Due to lack of estrogen, the vaginal walls thin out, its secretions reduce, and the normal vaginal flora is altered. This causes inflammation of the vaginal lining and pain and bleeding after sex. The mainstay of treatment for this condition is estrogen replacement therapy.
Pelvic organs prolapse
This is the downward displacement of pelvic organs, i.e., uterus, cervix, bladder and rectum, through the vagina. At times these organs prolapse beyond the vaginal opening. The condition is common in obese women and those with multiple vaginal births, chronic cough and constipation. This leads to backaches, pelvic pain and bleeding after sex.
Kegels pelvic floor exercises are recommended for mild degrees of prolapse. You are also advised to lose weight and get treatment for chronic cough or constipation. Surgical intervention is advisable for a severe degree of prolapse, affecting quality of life and not improving with kegels alone.
How do you stop bleeding after sex?
Get evaluated by your doctor before commencing treatment. Your doctor may want to know about your cycle's length, regularity and time period since your last cycle. In addition, inquiry is made of other associated symptoms, your pap test and change of sexual partner. A pelvic examination is usually done followed by relevant investigations to confirm the cause of bleeding. The treatment is tailored individually, depending upon the underlying cause.
To conclude
Postcoital bleeding is an issue many women face from time to time. Although most of the time, the underlying cause is not something to be worried about, it is advisable to get checked by your doctor. Cervical cancer is a concerning cause of postcoital bleeding and needs to be ruled out. Taking your routine pap tests for cervical screening is equally essential. If you experience bleeding after sex, set an appointment with your doctor.
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