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Is It Normal to Bleed After Sex?

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Photo: Getty Images/JulyProkopiv

If you've ever noticed spotting—or outright bleeding—after sex, you know it can be terrifying. Before you freak out, here's the good news: There are lots of potential reasons that bleeding after sex can happen, and many of them have easy fixes.

Still, it's important to get to the bottom of what's causing this common symptom, since it can indicate a variety of health issues. Here, eight reasons you could be spotting after getting it on.

You have this common condition.

If you're experiencing bleeding post-sex, most often, it's coming from the cervix," explains Amber Carriveau, DNP, FNP-BC a nurse practitioner and program director of the College of Nursing at Michigan State University. If you need a refresher, your cervix is the lower, narrow end of the uterus, which opens into the vagina. But there's a common condition that may make this more likely. 

"Cervical ectropion, found mostly adolescents and women under the age of 30, is a condition where the lining of the upper cervix is found on the vaginal side of the cervix." There's no single cause of cervical ectropion, but it can be the result of hormonal changes, hormonal birth control use, and pregnancy. Because the lining of the upper cervix is made from a different, more sensitive tissue, sex can easily irritate it and cause light bleeding. Usually, cervical ectropion goes away on its own, but in order to know if this is the reason behind your after sex bleeding, you'll need to undergo a pelvic exam.

Things are... dry... down there.

"Lack of sufficient lubrication may be the most common cause of bleeding after sex that's not due to a medical condition, whether because of the circumstances surrounding the sex activity (for example, new to vaginal sex, a little rougher than usual, or not enough foreplay) or because of hormonal factors," says Kelly L. Strutz, Ph.D., M.P.H., an assistant professor in the department of obstetrics, gynecology, and reproductive biology at Michigan State University. If you think this is the culprit behind your bleeding, Strutz notes that a good water-based or silicone-based lube may be all you need to fix the problem.

Your hormones are fluctuating.

Whether you're pregnant or going through menopause, life stages that come along with hormonal changes can also cause unusual post-coital bleeding. "In pregnancy, bleeding can often be seen after intercourse," says Phillis Mims-Gillum, M.D., FACOG, CSC, a senior staff physician and AASECT certified sex counselor at Henry Ford Health System. Pregnancy hormones cause the cervix to become more sensitive than usual, so sex could irritate it and thus, cause a small amount of bleeding. (A larger amount of bleeding during pregnancy should, of course, be evaluated by your ob-gyn in case it's something more serious.)

Other hormonal causes of dryness include birth control side effects and declines in estrogen after pregnancy or leading up to menopause, says Strutz. Many forms of birth control can cause breakthrough bleeding, which is sometimes mistaken for post-sex bleeding, and a decline in estrogen can lead to vaginal dryness. "Sometimes lube helps in these situations, or you may want to ask your health care provider about vaginal estrogen treatments," says Strutz. (BTW, here's more info on the most common birth control side effects.)

You have an STI.

"Many of the common STIs can cause bleeding," says Strutz. "Some, like herpes, cause sores that can bleed easily when disturbed. Others, like gonorrhea and chlamydia, can lead to bleeding due to infection of the cervix (cervicitis), uterus, Fallopian tubes, or ovaries." Those infections can lead to pelvic inflammatory disease, which is a more serious infection of your reproductive tract. "Watch out for other signs of infection, such as pelvic pain or fever," Strutz advises.

It's also worth noting, though, that many women infected with STIs don't display any symptoms, so if you have any doubts about your STI status or simply haven't been tested in a while, it's a good idea to check in with your health care provider about testing.

A yeast infection or BV is stirring up trouble.

Aside from STIs, vaginal infections that aren't sexually transmitted, like yeast infections and bacterial vaginosis (aka BV) can sometimes cause bleeding after sex. Yeast infections happen when there's an overgrowth of fungus naturally found in your vagina, and BV happens when there's an imbalance in the bacteria naturally found in your vagina.

"Both of these can cause irritation of the vaginal tissue and in some cases bleeding after sex," says Carriveau. But if you've got either of these infections, bleeding after sex probably won't be your only symptom. "Other symptoms of these types of infection include pain or irritation with intercourse and vaginal discharge or odor," she adds. If you suspect either of these infections is the cause of your bleeding, consult your health care provider, as it can be difficult to tell the difference between yeast infections and BV on your own, and the treatments are different.

You have polyps or fibroids.

Two types of growths on pelvic organs can cause post-sex bleeding: polyps and fibroids.

"A cervical polyp is a benign (non-cancerous) growth on the cervix," explains Carriveau. We don't know why they happen, but it's usually recommended to have them removed, and they're often discovered during routine pelvic exams. "A polyp may become irritated during sex and bleeding can occur."

Fibroids, on the other hand, grow in the uterus and often cause bleeding that may or may not be associated with intercourse, says Char'ly Renee Snow, certified nurse midwife and director of midwifery services at Henry Ford Health System. One red flag that you might be dealing with fibroids? "Painful and heavy menstruation frequently accompany fibroids," says Snow. Usually, they're diagnosed via ultrasound. "The management of fibroids depends on the severity of symptoms and should be discussed with your provider."

Something more serious could be going on.

"Abnormal bleeding can also be seen in cancerous and precancerous conditions of the vagina, cervix, and uterus," says Dr. Mims-Gillum. That doesn't mean you should freak out about post-sex bleeding, though. More likely, the cause is something that's *not cancer.* Still, it's all the more reason to stay on top of your reproductive health by getting regular pelvic exams and pap smears.

The bottom line

Bleeding after sex is a pretty common concern, experts say. "The most likely cause depends on your age, pregnancy status, and risk for sexually transmitted infections," notes Carriveau. It's also possible that it's no big deal, she says. "If the bleeding is minor, and happens within a few days of your period starting or ending, it is probably fine to just monitor things, especially if you have recently had a pelvic exam and pap smear." So when should you head to the doctor's office? Pretty much any other time, especially if the bleeding is becoming routine or is anything more than light spotting.

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