Is vaginal bleeding after sex normal?

Why do I bleed after sex?

Bleeding after sex is a type of bleeding that happens during or after you have sex, which isn’t related to your monthly period. You may bleed after a penis, sex toy or finger is put into your vagina.

Known as postcoital bleeding (PCB), this can happen to anyone with a vagina, and can be worrying. The bleeding can range from very light spotting to heavy bleeding, and also vary in colour, from red to pink or brown.

If you’re having bleeding after sex, especially if it’s accompanied with pain, it's a good idea to see a doctor, so they can explore what might be causing it. If a cause is found, it isn’t likely to be serious, and can usually be easily treated if needed.

It’s rare, but PCB can be a sign of cervical cancer, so it’s important to get checked out if you’re bleeding after sex.

Common causes of bleeding after sex

If you bleed during or after intercourse, you may be bleeding from your vagina or from the entrance to your womb at the top of your vagina (cervix).
Vaginal bleeding can be linked to injury to the wall of your vagina – this is usually due to vaginal dryness or rough sex. You may also bleed because you have a skin problem on your outer genitals (vulva).

There are a number of causes of bleeding after sex that are linked to your cervix.

It won’t always be clear what’s causing PCB, but let’s look at some of the most common causes.

Cervical ectropion

Cervical ectropion is the most common cause of bleeding after sex in younger people, especially if you’re using the combined oral contraceptive pill (the pill) or are pregnant – though it can also happen without any cause. It’s a natural response to any changes in your levels of the hormone oestrogen.

It happens when cells that are usually found inside your cervix grow outside of it and are exposed to your vagina. These cells bleed very easily, even if lightly touched. So when anything is put into your vagina during sex, this sensitive area may become irritated and bleed.

Cervical polyps

These are small growths that can develop inside your womb or on the surface of your cervix. As they get bigger, they can stick out of your cervix and, because they have a rich blood supply, they bleed easily if touched or irritated during sex.

Cervical polyps aren’t cancerous and they won’t change into cancer.

Vaginitis and cervicitis

Vaginitis is soreness and swelling (inflammation) of your vagina.

It’s often due to thrush (candidiasis) or another type of infection. Thrush is a common yeast infection that can cause symptoms such as vaginal discharge and bleeding, as well as itching and discomfort.

Other types of infections that can cause you to bleed after sex include sexually transmitted infections (STIs) such as chlamydia, gonorrhoea or trichomoniasis. These can cause inflammation in your cervix (cervicitis) and also pelvic inflammatory disease (PID). If you think you're at risk of an STI, see a doctor or visit a sexual health clinic.

Vaginal dryness

A number of things can cause a dry vagina, including taking the pill, breastfeeding, some cancer treatments or having your womb removed (hysterectomy).

Vaginal dryness is also more common after the menopause, as your levels of the hormone oestrogen are lower, which causes your vaginal fluid (secretions) to decrease.

If your vagina is dry and isn’t lubricated during intercourse, the friction caused by penetration can irritate and tear its fragile lining, leading to bleeding after sex.

Rough sex

Rough sex – especially without enough lubrication – can cause bleeding from the walls of your vagina. This can happen if sex toys are used too forcefully or if your partner has metal genital piercings, for example.

Less common causes of vaginal bleeding after sex

• endometriosis – a painful condition where the tissue that lines your womb grows outside your womb, which can cause PCB
• cervical cancer – a rare but serious cause of PCB. Regular cervical screening tests will reduce your risk
• womb cancer – in rare cases, abnormal vaginal bleeding can be a sign of cancer of the womb (also called endometrial cancer)

When to see a doctor

If you have very heavy vaginal bleeding, you should call an ambulance or get emergency medical help, especially if:

• it won’t stop
• you’re feeling faint or you do faint
• you have a very fast heart rate
• you have cold, clammy skin
• you have severe tummy pain
• you’re pregnant

You should also see a doctor within a few days if you have any unusual vaginal bleeding, including:

• after sex
• between periods
• during pregnancy
• after the menopause

You should mention any other symptoms, such as pain or vaginal discharge, too.

The doctor will ask about your medical history, if there’s been any recent change in your sexual partners, and what contraception you’re using. They may also check when you last had a cervical screening test and examine you for signs of infection.

If you think the type of hormonal contraceptive you’re using may be causing your bleeding, discuss this with your doctor.

What’s the treatment for bleeding after sex?

The treatment of PCB varies, depending on what’s causing it.

Cervical ectropion

If cervical ectropion needs treating, the usual treatment is cauterisation. This painlessly removes the cells on the outside of your cervix, using either heat, freezing treatment or silver nitrate. After treatment, you should avoid sex for up to 4 weeks.

However, cervical ectropion doesn’t always need treatment, as it often doesn’t cause any problems or symptoms. It isn’t linked to cervical cancer, and often goes away on its own.

Cervical polyps

Small polyps can be removed very simply by twisting them off the cervix, and you won’t need a local anaesthetic. For larger ones, you’ll have a local anaesthetic to numb your cervix, before they’re removed using a heated wire loop.

If polyps aren’t causing symptoms, however, they don’t need any treatment.

Vaginitis

Treatment involves treating the infection that’s causing vaginitis, such as thrush, a bacterial infection or an STI. You may be given antibiotic, antifungal or antiviral medication.

If you have an STI, your partner will also need treating. Having safe sex and using barrier contraception, such as condoms, can help prevent STIs.

Vaginal dryness

Oestrogen is the most effective treatment for vaginal dryness (atrophic vaginitis). It restores your vagina’s natural acid balance (pH) and improves lubrication.

Using vaginal lubricants and moisturisers can also help.

Rough sex

When you have sex, using plenty of lubrication, such as a water or silicone-based vaginal lubricant, will help prevent damage to your vagina. You may also want to avoid penetration that is too forceful or rough.

What’s the outlook if you bleed after intercourse?

In many cases of PCB, the bleeding settles down over time and no obvious cause is found. And the majority of cases that do have a cause can be easily and successfully treated.

If cervical cancer is the cause of bleeding after sex, the earlier it’s diagnosed, the better the long-term outcome. Keeping up to date with your cervical screening tests can help prevent cervical cancer.

Key takeaways

• bleeding after sex is bleeding from your vagina after something is put into it – it isn’t linked to your periods
• it can be caused by a number of things, most of which aren’t serious and can be easily treated
• in many cases, no obvious cause is found
• you should always speak to a doctor about bleeding after sex
• in rare cases, bleeding after sex is a sign of cervical cancer. Regular cervical screening will help prevent this