Bleeding After Sex:
It is quite common for females to complain of bleeding from the vagina which is not related to menstrual periods. It is in fact the most common course of embarrassment and social distress to many females and accounts for significant number of visits to the primary care provider. It is also quite worrisome for the patient for fear of having something which can be quite serious like a malignant condition. One such type of abnormal bleeding that is seen in female is during sexual intercourse. This in medical terms is known as postcoital bleeding and occurs during or immediately after sexual intercourse. This condition occurs in about 6% of females in the reproductive age group. Additionally, about 30% of females with bleeding during sex also complain of abnormal uterine bleeding and about 20% complain of dyspareunia [1].
There are many causes for bleeding after sex which can range from benign and harmless to something more serious. It can occur as a result of lesions in the genital tract or inflammation of the cervix. Females with cervical polyps at times also complain of abnormal bleeding after sex. In rare cases, this condition is a sign of something more sinister like cancer which accounts for about 5% of all cases of bleeding after sex, especially cervical cancer [1].
However, there is significant variation in the data seen when studies are conducted in the underdeveloped countries as the prevalence of cervical cancer is much more in these regions than in the developed nations. This is because of better awareness of the condition and better facilities for screenings for such types of cancers. If a female indulges in sexual activity while she is menstruating then it is quite common to experience bleeding after sex and it is not considered to be pathological in any way [1].
There is no age prevalence with regard to experiencing bleeding after sex and female of any age can have it after attaining puberty. This article explains some of the causes of bleeding after sex and different ways to treat the condition [1].
What Causes Bleeding After Sex & How To Treat It?
Some of the causes of bleeding after sex include:
Trauma: If the vagina is not adequately moist or lubricated during sexual intercourse then the friction that is caused due to the penis penetrating the vagina can often at times causes small tears or abrasions in the sensitive tissues. This is what leads to bleeding after sex. An injury or trauma can also occur during the delivery of a baby. This happens when the baby comes out of the birth canal and causes a tear or abrasion in the vaginal area [2]. A female can also injure the vaginal area when having sexual intercourse for the first time. This is because there is a tiny skin flap called the hymen which covers the vagina and gets broken during sex. The bleeding because of this can last anywhere from one to two days and the bleeding is not heavy [2].
Vaginal Dryness: This is perhaps the most common cause of bleeding after sex. This is because when the skin around the vagina is dry, it increases the risk of injury as a result of friction or excessive stretching. The tissues that function by lubricating the vagina are extremely sensitive and can get damaged easily due to the dryness. The common causes of vaginal dryness include [2]:
Menopause: This is the most common cause of vaginal dryness. When a female attains menopause the estrogen levels in the body decline. The estrogen functions by lubricating the vagina and if the levels fall this leads to dryness around the vaginal area. The vaginal also loses its elasticity making it tougher for the penis to penetrate it during sexual intercourse [2].
Removal of Ovaries: This is yet another cause of vaginal dryness. Often at times, a female sustains irreparable damage to the ovaries or suffers from a medical condition which requires removal of the ovaries. As ovaries produce estrogen in a female, when it is removed there is significant depletion in the levels of this hormone which causes the vagina to become dry [2].
Childbirth: When a female is pregnant, the levels of estrogen are extremely high. However after the delivery of the child, the levels drop down drastically as estrogen can impair production of breast milk. This is what results in vaginal dryness [2].
Medications: There are also certain medications that can cause vaginal dryness. These medications generally work by lowering the estrogen levels in the body. These medications include common cold medications, steroids, antidepressants, and calcium channel blockers [2].
Irritants: There are several chemicals like the ones used in swimming pools and water parks and other detergents that all can irritate the vaginal area and contribute towards vaginal dryness [2].
Infections: This is yet another cause of bleeding after sex in females. Any infection which involves the external female genitalis to include the vagina or its tissues can result in the female experiencing bleeding after sex. The most common infections contributing to this are pelvic inflammatory disorders, vaginitis, inflammation of the cervix, and most commonly sexually transmitted diseases like gonorrhea and chlamydia [2].
Cervical/Endometrial Polyps: At times, fibroids or polyps around the cervical area or around the endometrium can lead to bleeding after sex. These are benign overgrowths which are most common in the cervix and the uterus. This is especially seen in female of reproducing age. The primary presenting feature of a cervical and uterine polyps or fibroids is abnormal vaginal bleeding and this may occur at times after sex [2].
Cervical Ectropion: This is a condition in which the glandular cells present within the cervix start growing abnormally outside of it. This is quite a harmless condition and resolves spontaneously but it can cause bleeding after sex [2].
Endometriosis: This is a condition in which the tissues that line the uterus and is present on the inside half of the uterus starts to grow outside of it. This results in inflammation around the abdominal and pelvic region. This also results at times in bleeding after six [2].
Cervical Dysplasia: This is a condition in which there is abnormal growth of precancerous cells along the cervical canal. This is the opening that connects the uterus and the vagina. These abnormal growths tend to irritate the areas around the vagina and cause bleeding after sex [2].
Anatomical Disorders: Some females congenitally have reproductive organs that are not shaped normally or are out of place. These may also result in a female to have bleeding after sex [2].
Bleeding Disorders: Some females have problems with clotting of blood causing easy bleeding. This may result in the female bleeding even with little friction during sexual activity causing bleeding after sex [2].
Cancers: Certain forms of cancer also at times cause bleeding after sex. This happens due to the malignancies affecting the reproductive system or the urogenital tract that affect the hormone levels and even damage the vaginal tissues. This is what results in bleeding after sex. In fact, bleeding after sex is the primary symptom of uterine and cervical cancers [2].
Thus it is recommended to consult with a physician in cases where the bleeding after sex is severe. Consultation is also recommended if there are other symptoms associated with bleeding after sex. These symptoms include abnormal discharge from the vagina, itching around the vaginal region, severe abdominal pain, unintentional loss of weight, and appetite loss, as they may indicate presence of a cancer [2].
Treatments: Coming to treatment options for bleeding after sex, it basically depends on the underlying cause of the condition. For vaginal dryness, the female can use medicated moisturizers without any fragrances or artificial perfumes. These are available easily in pharmacy stores. If a bacterial infection is the cause of the bleeding then a course of antibiotics will be administered to treat the infection which still stop the bleeding. This is specifically used for sexually transmitted diseases caused by gonorrhea or syphilis [2].
Viral infections can be treated with antiviral medications. If cervical polyps or fibroids are the cause of bleeding after sex then generally a surgical procedure to remove the fibroids and polyps will be required. In rare cases if cancer is believed to be the cause of bleeding after sex then treatment for the condition will be required [2].
Bleeding after sex due to low estrogen levels can be addressed either through topical estrogen creams or hormone replacement therapy. However, chronic use of hormone replacement therapy has a significant side effect profile and thus this should be done under the guidance of a physician [2].
In conclusion, bleeding after sex is quite common and is usually caused due to an injury or trauma as a result of vaginal dryness. If the vagina is not adequately lubricated during sex then the friction during sexual activity causes tear or stretching of the vagina causing bleeding after sex. Vaginal dryness is quite common in menopausal females due to declining levels of the hormone estrogen. This hormone is produced by the ovaries and functions by lubricating the vagina. Thus any problems related to ovaries can cause a decline in estrogen levels [2].
Additionally, childbirth is also one of the causes of a low estrogen levels. For females who still have their menstrual periods, bleeding after sex normally stops spontaneously until it is caused due to serious medical conditions like endometriosis, cervical polyps, uterine fibroids, or in rare cases cancer [2].
Thus it is recommended that people who have severe bleeding after sex and is accompanied by other symptoms that may point towards an underlying medical condition should consult with a physician. This will be to pinpoint a diagnosis and start treatment for it. For bleeding after sex caused by a damage or tear, it usually resolves spontaneously and requires not much treatment apart from antiseptic creams and lotions that can be bought over-the-counter. In cases of fibroids and polyps, surgery is required to remove them and treat the abnormal bleeding after sex [2].
