If you've ever gone to the toilet post-sex and looked down to notice spots of blood, it can be a scary feeling. Your mind instantly races to the worst possible scenario, and furious Googling probably doesn't help. But while the chances are slim that your post-coital bleeding is actually indicating the likes of cancer, Dr. Pixie McKenna, general practitioner at The London Clinic, advises that you always, always get it checked out.
"It's an embarrassing symptom and that's the thing; people will often put off going to the doctor," says Dr Pixie. "But we're not bothered, so you shouldn't be either. We're not there to stand in judgment."
Bleeding following intercourse could be down to a multitude of things, she explains, all of which are detailed below, but Dr. Pixie does want to remind you of one important thing before you do go and get it checked out:
"If you go and see a GP or another healthcare professional about post-coital bleeding, anticipate that you're going to have an examination. You need to psyche yourself up for it," she says.1. Sexually Transmitted Infection
"STIs are certainly a very common thing to consider, even if you haven't had any symptoms of anything else, like discharge, pain, or change in your urination," says Dr. Pixie. But if you do experience bleeding after sex, you should consider that it could be an STI. "A lot of women who have 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," the doctor notes. "But it's important to detect, particularly with chlamydia, because it can have long-term consequences for people which could ultimately lead to infertility."
And even if you last had unprotected sex months ago but you've only just started post-coital bleeding, don't rule out an STI, says Dr Pixie. "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," she says.2. 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 gonorrhea, mycoplasma, ureaplasma, or anything really," says Dr. Pixie, who notes that in some 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 low-grade pelvic pain, discharge, as well as urinary issues if you think you might have PID. "A lot of patients I've had in the past have thought they've had recurring cystitis and actually they've had a sexually transmitted infection which took a while to diagnose," says the doctor.3. Vaginal dryness
If you have very dry vaginal tissues, this could be another potential cause of bleeding after sex. Menopause can trigger this, but that's obviously unlikely for young women, so it's more likely to be down to having lower levels of estrogen. "Women with low estrogen may not be having regular periods or they may have a very low body mass index," says Dr. Pixie, who adds: "Anyone who has any skin conditions down there, like psoriasis, make the skin more likely to bleed. In this instance, you can use a lubricant to ease vaginal dryness, but always remember if you are using lubricant to make sure they are water based, and keep them as boring and as basic as possible, so none of this tingly jingly jangly stuff! Go for the most straight forward option."
"Pregnancy can cause bleeding," says Dr. Pixie, advising a pregnancy test if you're particularly 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.5. Rough sex
It makes sense that sex, which gets a little more vigorous, could cause more friction and therefore enough trauma to potentially make you bleed; as well as "sex with a new partner, different positions, or something you're not particularly used to," says the doctor. She also adds: "If you've got a partner who's got any body piercings, they can obviously cause bleeding on occasion." Dr Pixie goes on to clarify that with these kind of causes, you can tend to "do the analysis yourself to work out whether it's likely."
6. Not having had sex in a long time
While Dr. Pixie confirms this can lead to bleeding—"a once-off bleed after restarting your sexual career after a long break is probably innocuous," she says—she does clarify that any recurrence would rule this out as a cause. And in that case, "you've got to be sensible and get it looked at," she says, "because none of us can look at our own cervix. Even if you're a doctor and you've got the best equipment in the world, somebody else has got to do it for you. It's very important."7. Cervical ectropion
Dr. Pixie likens a cervical ectropion to a gynecological version of walking around with the inside of your lip exposed. "The cells inside your cervix can sometimes poke out externally and, just like the soft part of the lips, the lining is more delicate so it's going to get very irritated," she explains. "The inner cells poke out to the outside and they can become weak, meaning they can bleed on contact," says the doctor. This kind of contact could be made by a penis during sex.
Dr Pixie notes that "ectropion is much more common in women on the pill," and explains that it's "normally not a cause for concern long-term. It can settle down if you remove the thing that's causing it—so changing or coming off the pill," she says. Doctors might also decide to cauterize an extropion, which effectively burns the cells off using silver nitrate to make the tissues react and then heal.8. Cancer
Cervical cancer is the most common cancer in women under the age of 35, so it's obvious that this could be a concern for young women who bleed during sex, but it still doesn’t make it likely. "In terms of the likely causes of bleeding after sex, it's not a common cause of bleeding after sex, but it certainly is one of the presenting symptoms of cervical cancer," the doctor says.