Noticing spots of blood after sex can feel scary—and often our minds jump to the very worst case scenario, such as the bleeding being a sign of a gynecological cancer. While it's important to book in with your OB-GYNE to have it checked out, it's also highly unlikely to be caused by something sinister, says Dr Pixie McKenna, GP at The London Clinic. "It can be seen as an embarrassing symptom, meaning people will often put off going to the doctor about it, but we’re not bothered, so you shouldn’t be either. We’re not there to stand in judgment."
Bleeding following intercourse can be caused by a myriad of reasons, she explains—all of which are detailed below—and Dr McKenna also wants to advise that an examination is likely to be necessary. "If you go and see a GP or another healthcare professional about post-coital bleeding, anticipate that you’re going to have an examination." While these sort of check-ups aren't something any of us relish, (much like smear tests) they're incredibly important and will be over in minutes (if you're nervous, it can help to let your doctor know beforehand, as they may be able to offer extra support).
Is it normal to bleed after sex?
According to gynaecological cancers charity, The Eve Appeal, bleeding after sex is more common than you might think if you're pre-menopausal. "Most of the time it isn’t something to worry about," they say. "But do still note it down if it’s something you experience, as well as whether or not you experience any pain – it's always worth investigating."
The UK NHS website refers to bleeding after sex as "postcoital bleeding." They add that "in rare instances, bleeding after sex can be a sign of cervical or vaginal cancer", and that you may also need to take a pregnancy test when you visit a healthcare professional to discuss it.
What causes bleeding after sex?
"Sexually Transmitted Infections (STIs) are certainly a very common thing to consider if you've bled after sex, even if you haven’t had any other symptoms, like discharge, pain or change in your urination," says Dr McKenna. "A lot of [women and people with vaginas] who've had an unprotected sexual encounter will look for the morning after pill but, in the absence of symptoms, may not go any further in terms of checking themselves for STIs." It’s important to detect if you have an STI, particularly chlamydia, as it can have long-term consequences, such as ultimately leading to infertility.
"Even if you last had unprotected sex months ago, but you’ve only just started post-coital bleeding, don’t rule out an STI, adds Dr McKenna. "The length of time after contracting an STI that you’d bleed very much depends on the person, so the fact that you might have started bleeding now and you only had sex two months ago is irrelevant." The majority of STIs can be cured quickly and easily through medicine, and can be checked for via swabbing or a quick blood test.
PELVIC INFLAMMATORY DISEASE
This usually occurs as a long-term result of an undetected STI, and can also lead to bleeding during or after sex. "It can be down to a number of infections, one of which is chlamydia, but it can also be gonorrhoea, mycoplasma, ureaplasma, or anything really," says Dr McKenna, who notes that on rare occasions Pelvic Inflammatory Disease (PID) can also be caused by infections that haven’t been transferred sexually. Look out for other symptoms such as a niggly, low-grade pelvic pain, discharge, as well as urinary issues if you think you might have PID. "I’ve had patients in the past who thought they were experiencing recurring cystitis, when actually they had a sexually transmitted infection that took a while to diagnose."
Vaginal dryness could be another potential cause of bleeding after sex, as not being fully lubricated down there (sometimes diving straight into penetration doesn't allow enough time to get wet) can lead to vaginal tearing. Menopause can also trigger dryness, but that's unlikely to be the cause for a younger woman, explains Dr McKenna, adding that having lower levels of oestrogen can also be a factor. "Women with low oestrogen may not be having regular periods or they may have a very low body mass index," she says. "Anyone who has a skin condition around their vagina which make the skin more likely to bleed, such as psoriasis, could also consider that a possible cause." She advises using a water-based lubricant to ease any vaginal dryness. "Keep the lube as boring and as basic as possible. Go for the most straight forward option."
"Pregnancy can cause bleeding," says Dr McKenna, advising a pregnancy test if you’re concerned. She does, however, note that it’s probably worth exploring other options – STIs and other cervical issues – alongside this unless you're expecting to be pregnant. If you're already aware that you're expecting, bleeding during pregnancy could be worrying, but a visit to your GP should hopefully alleviate any concerns. It certainly isn't always cause for concern (but it's best to double check).