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.
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.
"Even if you're not eligible for a smear, see your doctor and have a physical examination carried out. It's really important," she says.
But bleeding during sex could be an indication of any of the gynecological cancers, notes Dr. Pixie, including endometrial cancer, vulval cancer, and more. The smear test doesn't account for these, so you'd need to get an examination, but you'd likely be presenting other symptoms alongside post-coital bleeding. "With vulval cancer, women will have had some type of lesion, growth, or some type of change in the external skin of their genitals," says Dr. Pixie. "But of course, unlike our male counterparts, we're not continually examining our bits and sometimes we don't really know what we're looking for anyway because we're not hugely familiar with our own anatomy. So if in doubt, get checked out," she says.
9. Severe thrush
"If you had a bad thrush infection that was affecting your vulva, becoming vulva vaginitis, then the trauma of sex could cause this to bleed," says Dr. Pixie, adding that it's extremely rare. The reason for bleeding in this instance would be due to inflammation and irritation externally to your genitals.
Polyps, which Dr. Pixie describes as harmless "little fleshy growths" which can grow anywhere on the body, can be a cause of bleeding after sex when they grow on the cervix. "They're very vascular so they tend to poke out through the neck of the cervix and they can be traumatized during sex, bleeding as a result," says the doctor. "Your examining healthcare professional will be able to see a polyp when they take a look, and then they can be treated. Usually they need to be removed even though they're benign which means they're not cancerous, but they can be quite annoying," adds Dr Pixie.
As you can see, there are lots of potential causes for your post-coital bleeding, and you needn't worry that it's the worst possible scenario until you've got it checked out by a medical professional. "It's usually something very straight forward," says Dr. Pixie, "but that doesn't mean that people should assume it's nothing; you've got to get it checked."
This article originally appeared on Cosmopolitan.com/uk. Minor edits have been made by the Cosmo.ph editors.