Bleeding after sex: common causes and when should you see a gynaecologist?

English version

Bleeding during or after sexual intercourse that is not part of a menstrual period is called postcoital bleeding. It may appear as a few spots of pink, red or brown blood, or occasionally as heavier bleeding.

The cause is often non-cancerous, particularly in younger women. Nevertheless, unusual bleeding should be assessed rather than repeatedly attributed to friction or an approaching period.

What can cause bleeding after sex?

• Vaginal dryness, insufficient lubrication, friction or a small vaginal injury.
• Dryness and thinning of vaginal tissue during breastfeeding or after menopause.
• Inflammation or infection of the vagina or cervix.
• A sexually transmitted infection such as chlamydia.
• Cervical ectropion, where delicate cells from inside the cervix are present on its outer surface.
• A cervical or uterine polyp.
• Bleeding associated with pregnancy.
• Less commonly, abnormal or cancerous changes affecting the cervix, vagina or uterus.

Bleeding after sex does not automatically mean that cancer is present. However, it is a symptom that should be medically checked, particularly if it recurs.

Which accompanying symptoms matter?

• Unusual, yellow, green or foul-smelling discharge.
• Pelvic or lower-abdominal pain.
• Pain, burning or dryness during sex.
• Itching, sores or blisters.
• Burning or pain while passing urine.
• Bleeding between periods or periods becoming heavier or irregular.
• A missed period or possible pregnancy.
• Tiredness, dizziness, breathlessness, unexplained weight loss or persistent pelvic pressure.

These symptoms may guide the examination and choice of tests, but they cannot establish the cause by themselves.

When should you arrange a consultation?

• Bleeding after sex has occurred more than once, is increasing or does not stop quickly.
• You also bleed between periods or have pain, dryness or unusual discharge.
• Symptoms began after unprotected sex or with a new partner.
• You are pregnant or may be pregnant.
• You have missed cervical screening or previously had an abnormal result.
• Bleeding occurs after menopause.
• You take blood-thinning medicine.
• The symptom worries you, even if it occurred only once.

Any bleeding after menopause should be assessed, including a single episode of light spotting.

What assessment may be needed?

• Pregnancy testing and examination of the vagina and cervix.
• Testing for vaginal or sexually transmitted infections.
• Cervical screening if due or clinically appropriate.
• Pelvic ultrasound, colposcopy or further assessment of the uterine lining when indicated.

Not every patient requires every test. A normal previous cervical-screening result is reassuring, but it does not identify every possible cause of current bleeding or replace assessment of symptoms.

What can you do meanwhile?

If bleeding followed obvious dryness or friction, avoid further penetration until soreness and bleeding settle. A water-based lubricant may reduce future friction. Avoid vaginal douching, perfumed intimate products, and antibiotics or antifungal medicines without a clear indication. If infection is possible, avoid sexual contact or use a condom until you have received advice and any necessary testing.