It is often nothing to worry about, or is caused by an easily treatable condition, but in rare cases it can be an indicator of cervical cancer. If you notice that you are bleeding after sex, and you are not on your period, it is important to get checked out to find the source.
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The causes of postcoital bleeding are:
- Sexually transmitted infections such as chlamydia or gonorrhea, or bacterial infections such as pelvic inflammatory disease (PID)
- Damage such as tears from childbirth, or from friction and lack of lubrication during sex
- Vaginal dryness (atrophy or atrophic vaginitis) caused by hormonal changes (lower oestrogen levels) in postmenopausal women, which cause reduced vaginal secretion and thinning of the vaginal tissue, which can lead to tears
- Hormonal birth control can destabilise the lining of the uterus, causing it to shed at random
- Cervical polyps
- Inflammation of the cervix (cervical ectropion, which is common during the ovulatory phase of the menstrual cycle)
- Ovulation, at the mid-point of the menstrual cycle around day 14, can prompt shedding of small areas of the endometrium (uterine lining), due to the spike in oestrogen levels
- Cervical or vaginal cancer (in rare instances).
In order to diagnose the root cause of vaginal bleeding after sex, the doctor may recommend an internal pelvic examination (performed manually), an examination of the cervix using a speculum or microscope, or a pregnancy test, depending on your other symptoms.
In many cases, postcoital bleeding is nothing to worry about, but it can be the sign of something more serious, so it is always recommended that you see a doctor immediately if you notice bleeding after sex.
The most serious causes are cancer, STIs, and bacterial infections. More common causes are vaginal dryness, lack of sufficient lubrication during sex, or hormonal changes.
Depending on your other symptoms, the doctor may give you an internal pelvic examination, examine your cervix with a speculum, or test for pregnancy.