Bleeding after the first time you have sex (while not a given) is expected—when the hymen stretches (usually called "breaking"), some light bleeding can take place immediately or a few hours after sex. But postcoital, vaginal bleeding can happen pretty much anytime, not just the first time. About nine percent of all women experience postcoital bleeding (outside of first sex) at some point in their lives. It could be caused by something as simple as not using enough lube, but it can also be a sign of something more serious.
To offer some guidance on when you should just give your vagina a rest for a few days and when you should see a doctor right away, Cosmopolitan.com spoke with Dr. Anne-Marie Aimes Oelschlarger, a pediatric and adolescent gynecologist at Seattle Children's Hospital, about all the different things vaginal bleeding after sex can mean.
CLEARING UP A MYTH ABOUT HYMENS
Before getting into regular degular postcoital bleeding, it's a good time to clarify what actually is happening when you bleed after the first time you have sex. The common phrase for this (that is in great need of retirement, just IMO) is "popping your cherry," or "tearing your hymen." But there's not really any popping or tearing taking place. The hymen is a thin piece of tissue inside the vaginal opening. Dr. Alyssa Dweck, a gynecologist in New York and author of The Complete A to Z for Your V, said that, the first time a person has sex, the hymen stretches, which can result in mild or moderate bleeding.
But the hymen can also stretch during other non-sexual activities, like riding a bike. People who say they never bled after sex probably had their hymen stretched before and just never noticed it. See? Much less aggressive than popping or breaking.
WHERE THE BLOOD COMES FROM
Vaginal bleeding after sex gets complicated fast because there are lots of different spots the blood can be coming from, and it's almost impossible to tell on your own, without the tools and expertise of a medical professional. Aimes-Oelschlarger said she breaks it down into four different locations: the entrance of the vagina at the hymen, inside the vagina (on the walls or in the septum, if you have one), the cervix, and inside the uterus.
Different things cause each of these locations to bleed, and they all vary in severity. The most immediately severe bleeding comes from a tear in a vaginal septum, which is a piece of flesh that divides the vagina in half that about 1 in every 3,000 to 80,000 women are estimated to be born with. Aimes-Oelschlarger said a tear in the septum can result in very heavy bleeding—like soaking through a pad every hour or so—and recommends going to the emergency room immediately if you suspect this has happened to you after sexual activity.
Bleeding from the other locations is harder to differentiate because there may not be a lot of blood and it's hard to peer up into your vagina with a flashlight to see what's going on up there. The most common source of bleeding in younger women, according to Aimes-Oelschlarger, is tiny fissures (or cuts) near the vaginal entryway that you may not notice until you touch the spot with toilet paper and feel a slight burn or stinging sensation. Another common source is from inside the uterus, which gets jostled around when you have sex or orgasm, and might shed some lining in the process. This is even more common if you're about to start your period in the next week or so.
HOW TO KNOW IF BLEEDING IS DANGEROUS
As Aimes-Oelschlarger explained, the most important thing to pay attention to is the volume and rate of the bleeding. Like any other wound, a lot of blood is never a good sign. "Most postcoital bleeding will be pretty light, except for the septum," she said. "It's pretty rare to have really heavy bleeding unless there's a laceration in the vagina. The heavy bleeding, where you're soaking through a pad every hour or so or passing large clots, those patients need to be seen very quickly."
She clarified that if you're passing a clot larger than the size of a quarter, soaking through a maxi pad, or feeling lightheaded or dizzy, you should go to the emergency room. But for lighter bleeding that subsides in a few hours or within a day or so, you can call your gynecologist and schedule an appointment.
WHEN YOU SHOULD SEE YOUR GYNECOLOGIST
Even though the bleeding might go away quickly, or not come with any sort of pain, Aimes-Oelschlarger said you should still plan to see your gynecologist. There are several STIs that can cause vaginal bleeding with sex (like HPV, chlamydia, gonorrhea, and trichomoniasis), and yeast infections and cervical and uterine polyps can cause bleeding as well. A visit to the gynecologist will rule all those things out, and polyps can be easily removed as well.
The most crucial reason to see your gynecologist, though, is that regularly bleeding from your cervix during and after sex can be an early sign of cervical cancer. Cervical dysplasia, or a change in the cells that line the cervix, is a precancerous condition that's often caused by HPV, and Aimes-Oelschlarger said it can cause bleeding. "Everyone needs to make sure they're up-to-date on their pap smears," she said. "If they've haven't had the HPV series, they need to make sure they've gotten that. Even if they're older."
At a gynecologist visit for postcoital bleeding, Aimes-Oelschlarger said you can expect your doctor to ask a series of questions to first figure out how severe the bleeding is and how commonly you might experience bleeding between periods. Then she said you'll probably test for STIs, HIV, and pregnancy, and then have an exam to rule out polyps, a yeast infection, or any larger fissures that might be on the wall or entry of your vagina. And even if you're up-to-date on your pap smears, your gynecologist still might recommend one, just to rule out the possibility of cervical cancer.
HOW YOU CAN PREVENT BLEEDING
As it is with almost every single preventable problem you can have with your vagina, Aimes-Oelschlarger emphasized the importance of lube. "If a couple has frequent intercourse—like multiple times during the day—or they have prolonged intercourse and they're not using enough lubrication, it's not uncommon to have a little light bleeding that should resolve within a day," she said. "Some people notice it more with condoms because they're not using lube that's appropriate with condoms. The message here is not to stop using condoms, but to use condom-safe lubrication."
She clarified that for older women, declining levels of estrogen can lead to more sensitive vaginal tissue that tears more easily. But women of all ages can experience small fissures if they're not properly lubricated—it has nothing to do with how feminine or sexy or cool you are, it's just a thing that happens to basically all ladies. Lube up! LUBE. UP.
Another way to prevent bleeding is to take things nice and slow if it's been a while since you've last had sex. "Be gentle," Aimes-Oelschlarger said. "If you haven't had sex for a while, go slowly. If you're with a partner who has trouble controlling himself, try changing positions so you have more control." And then, of course, you should always be having conversations with your partner, so the sex is fun and comfortable for both of you.
A very easy to way to do that? I'll say it once more: Always be using enough lube.
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This article originally appeared on Cosmopolitan.com. Minor edits have been made by the Cosmo.ph editors.