When you notice some spotting or bleeding after vaginal sex — perhaps on your bed sheets, in your underwear or on the toilet paper — it’s natural to be concerned.
Postcoital bleeding is a fairly common issue with a number of potential causes. “Many are benign and easily remedied, while some may represent a more serious problem,” OB-GYN Dr. Anna Barbieri told HuffPost.
It’s worth noting that sometimes the blood you see after sex may just be your period blood — especially if you notice it during, right before or right after your period. In that case, the blood may be part of menstruation, not actual postcoital bleeding.
Below, OB-GYNs explain some of the potential causes of bleeding after sex:
1. Vaginal Dryness
“Insufficient foreplay, not using enough lubrication and estrogen deficiency caused by perimenopause and menopause are the most common causes of vaginal dryness,” Ross, a women’s sexual health expert and author of “She-ology,” told HuffPost.
Friction from intercourse “can lead to minuscule tears in the vaginal tissues, leading to bleeding after sex,” Barbieri said.
Women who are breastfeeding may also experience vaginal dryness due to a drop in estrogen levels, she added. And some individuals on hormonal birth control will deal with this, too.
Vaginal dryness that’s causing painful sex or bleeding is quite common among patients in perimenopause and menopause, Barbieri noted, but can be “easily remedied” by using lubricants or topical vaginal estrogen cream.
2. Vaginal Or Cervical Injury
Bleeding may also occur if you’ve had rougher-than-usual sex or used certain sex toys, which can tear or injure the area, Barbieri said.
If you haven’t had sex in a while, you may also experience some lacerations at the entrance of the vagina, Ross noted.
It’s possible for deep penetration that bruises the cervix to lead to some discomfort and bleeding.
“If your male partner has a thick or long penis, this can cause trauma to the opening and back of the vagina,” Ross said.
Sexual assault can also cause vaginal bleeding. In the aftermath of sexual trauma, consider seeking medical care, calling a support line or mental health professional and reaching out to a trusted loved one.
Yeast infections and sexually transmitted infections such as chlamydia and gonorrhea can also be associated with bleeding after sex, Barbieri said.
“Inflamed and irritated tissue can bleed with friction and touch,” she explained.
4. Cervical Polyps
“These are common and benign — i.e., non-cancerous growths on the uterine cervix,” Barbieri said. If these are stimulated during sex, the tissue can bleed.
“Cervical polyps are identified during a vaginal exam; one typically would not ‘feel’ one by themselves,” she explained.
5. Cervical Ectropion
This is a benign and common condition in which the cells that normally line the inside of the cervix are present on the outside.
“The inner cervical lining is more prone to bleeding with stimulation/touch,” Barbieri said. Vaginal penetration may aggravate the delicate area.
Postcoital bleeding is seen in anywhere from 5% to 25% of people with cervical ectropion.
When you’re pregnant, having sex can lead to spotting or mild bleeding, “caused by increased blood flow and inflammation of the vagina and cervix,” Ross said.
Hormonal changes during pregnancy can make the cervix more tender and more susceptible to bleeding from sex.
Still, it’s a good idea to contact your doctor or midwife if you notice even light post-sex bleeding in order to rule out anything more serious. Bleeding that is heavy, prolonged or accompanied by pain or cramping should definitely be checked out ASAP.
Although rare, bleeding with intercourse can be a sign of cervical cancer “due to the increased vascularity of abnormal cells,” Ross said. It’s often one of the first symptoms.
Cervical cancer is, fortunately, one of the most preventable kinds “as long as you follow up with your gynecologist and have a routine screening done,” OB-GYN Dr. Philip Brzozowski told The Cleveland Clinic. “Cervical cancer tends to be very slow-growing over many years.”
When To Call Your Doctor
Post-sex spotting that’s caused by mild irritation of the cervix or superficial vaginal tears “should resolve on its own,” Ross said.
That being said, it’s still worth contacting your health care provider if you experience bleeding after sex, especially if it happens more than once, Barbieri said.
“I would encourage anyone with bleeding after sex to call their doctor. But it is particularly important to do if the bleeding is new, does not stop within a few hours — for example, dryness-related bleeding will typically be pink and will not last — is bright red, and is accompanied by pelvic, vaginal or abdominal pain and fever,” Barbieri said.
To help determine the cause of the bleeding, your doctor will typically take your medical history, perform a pelvic exam, do pap smear to rule out cervical dysplasia (pre-cancerous cells) and cervical cancer, and order an STI test and vaginal culture.
“The bottom line is once the cause is identified, treatment can be determined,” Ross said. “Bleeding or spotting after sex is terrifying. It’s most likely nothing to worry about but seeing your health care provider is always recommended.”