Let’s set the scene: you have just finished up with a passionate partner, or maybe you concluded a steamy self-love session when you notice blood. What should you do?
First and foremost, do some immediate self-care to ensure that there is no continuous/ongoing heavy bleeding or injury – you may enlist a partner to take a peek and make sure you aren’t missing anything. If there is blood in the area, clean yourself up with mild fragrance-free soap and warm water or with a product like Good Clean Love’s Balance Moisturizing Wash.
Second, the Women’s Health experts at Cleveland Clinic say that when it comes to post-coital bleeding (bleeding after sex), “Most of the time, it’s nothing major,” however, “bleeding after sex can sometimes signal a larger problem.” Before you jump to the worst possible conclusion, here are a few of the common causes of post-coital bleeding.
1. Menstruation
While you might feel like this is self-explanatory and recognizable, you can always double-check your period calculations to see where you are in your cycle. Remember that you may be experiencing breakthrough bleeding (spotting between cycles), and that spotting during ovulation is also common. Alternatively, if you have a long-term contraceptive method (like an IUD or Nexplanon, the arm implant), you might get an irregular period or random spotting.
If you have concerns about abnormal bleeding during your cycle, see your healthcare provider (HCP) and they may counsel you on certain methods of regulating menstrual cycles, like oral contraception.
2. Irritation or Trauma
Vaginal atrophy and vaginal dryness are annoying and frequent culprits of vaginal irritation following sex, especially intercourse. If it feels like a desert down there, know that there is absolutely nothing wrong with you and it has no reflection on how aroused you are or how attracted you are to a partner. Dryness is frequently a product of low levels of estrogen – estrogen levels tend to be low, for example, after menopause, following childbirth, throughout cancer treatment, while breastfeeding, etc. Natural lubrication is also affected by oral contraception, where you are in your menstrual cycle, some antihistamines (allergy medicine), some antidepressants, and other underlying health conditions.
Having sex without sufficient lubrication can lead to friction (think rug burn… in your vagina), and microtears of the vaginal tissue. Also, if you have experienced physical trauma, like an injury, sex may be irritating or inflaming the injury/trauma, which could cause bleeding.
Irritation and trauma take time to heal but can be aided by certain lubricants and moisturizers – some of which you can get over the counter, some of which you can get from your HCP. The best way to prevent irritation is to use the appropriate lubricant during sexual activity, especially during intercourse.
3. Hymen disturbance
Whether or not you have had sex (especially penetrative sex) before, parts of your hymen may still be intact, and when disturbed, it can cause bleeding. The hymen is very misunderstood – it is a thin piece of tissue at the vaginal opening that stretches to accommodate tampons or penetration – think of it as like a scrunchie just inside the vaginal opening. While hymen disturbance/tearing/stretching may cause mild pain and bleeding, there is no need to be concerned, unless you have ongoing pain, discomfort, or bleeding.
Fact or Fiction: Hymen Edition
In our society, especially when we are growing up, we are often taught to equate an ‘intact’ hymen with virginity First, let’s address the idea of ‘virginity.’ Virginity is a social construction (deeply founded in religion) that has no root in biology or physiology – this means that, in a sense, virginity isn’t real. It cannot be proven or shown and any attempts to do so are misled endeavors to draw “conclusions about women’s and girls’ sexual history…based on assumptions about… a small membranous tissue with no known biological function, which typically occupies a portion of the external vaginal opening in females.”
There are long-standing socio-cultural practices of ‘virginity testing’ when in reality, experts in the field have come forth and said “Hymen is not an accurate indication of virginity.” A wide misconception is that the hymen covers the whole vaginal opening – if this is the case, it is called an imperforate hymen and it actually requires medical attention. This is rare and only happens in about 0.1% of newborn females. It is actually not abnormal for babies to be born without a hymen at all and many people’s hymen are “broken accidentally by tampon use or vigorous exercise.”
If you’re thinking that ‘virginity testing’ rings a bell, but not because of religion, you may remember a few years ago in 2019, rapper T.I. came out on a podcast and admitted to bringing his daughter annually to the gynecologist to check to see if her hymen was still intact. Not only is this a violation of his daughter’s right to privacy and autonomy, but it’s entirely pointless – you cannot prove whether or not someone has had sex by looking at their hymen.
4. Infection
While it might not be, bleeding after sex can indicate infection, cervicitis, or vaginitis. Some STIs that can cause bleeding include chlamydia, gonorrhea, pelvic inflammatory disease (PID), and Human papillomavirus (HPV). Other STIs can cause pain during sex, like trichomoniasis and chlamydia. Cervicitis can cause bleeding and changes in vaginal discharge and can be caused by STIs and bacterial vaginosis (BV) and is an “imbalance of the naturally occurring bacteria in the vagina.” If you have a preexisting STI like herpes or syphilis that causes genital sores, irritation of these sores can cause bleeding.
You should visit your HCP to receive treatment which may include a physical exam, discussion of your health history, and prescribed antibiotics or a comparable appropriate course of treatment.
5. Benign Growths and Conditions
There are a few types of benign (non-cancerous) growths and conditions that can cause post-coital bleeding, including but not limited to cervical polyps, endometrial polyps, cervical ectropion, and pelvic organ prolapse.
Cervical polyps are growths on the cervix that result from cervical trauma (for example, if a penis or dildo forcefully comes into contact with the cervix) or hormonal causes and appear in about 4% of gynecologic patients. They most often occur in those who have had multiple births and are middle-aged and they easily bleed if they are touched.
Cervical ectropion refers to “the inner lining of the cervix protrudes through the cervical opening and grows on the vaginal part of the cervix.” It is most frequently seen in teenagers, those taking oral contraceptives, and during pregnancy.
Endometrial polyps, or uterine polyps, are growths in the endometrium and are usually non-cancerous, though some can be precancerous. Due to this condition being estrogen-sensitive, being perimenopausal and postmenopausal puts a person at higher risk for endometrial polyps, in addition to being hypertensive, experiencing obesity, and taking tamoxifen (a breast cancer treatment).
Pelvic organ prolapse is most likely to occur in those who have given birth in the past, have had a hysterectomy (surgery to remove the uterus), and those who have completed menopause. When pelvic floor muscles and ligaments weaken, “pelvic organ can drop lower in the pelvis, creating a bulge in the vagina (prolapse).” This may cause feelings of pressure in your pelvis and requires medical attention.
6. Malignancy
Post-coital bleeding, while not the most likely, can also be a sign of pre-cancer and cancers like endometrial cancer, vaginal cancer, and cervical cancer.
When to Seek Help
If you have any concerns about your post-coital bleeding and/or abnormal bleeding, you should talk to an HCP or comparable resource. You have a human right to the highest degree of health that is attainable. Trust your intuition and your gut (literally) if you think something is wrong, and you can always get a second or third opinion if you aren’t getting the answers you need.
Remember that this blog post is not medical advice nor should it be used as a tool for diagnosis. If you are concerned about something you read in this blog and how it might apply to your health, feel free to print it out or send it to your HCP.
Bonus: Guides to Stain Removal
Written by:
Gillian ‘Gigi’ Singer, MPH
American Board Certified Sexologist, Sexuality Educator, and Sex Ed Content Specialist
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