Whether you're into vanilla sex or like to get rough and wild, chances are you've probably dealt with postcoital bleeding (bleeding after sex) at one time or another.
Bleeding During Sex? Here's What to Know
While it's not the most pleasant of experiences, bleeding after sex isn't usually a cause for concern. According to a review published in Obstetrics and Gynecology International, 0.7 to 9% of menstruating people experience bleeding during or after sex.
In some cases, bleeding after sex could signify a more serious health problem, such as infection, endometriosis or cancer. That said, it's a good idea to learn what's normal and what's not when it comes to bleeding after sex so you can identify potential problems.
Read on to learn more about potential causes of postcoital bleeding and how you can be more proactive about your health.
Why Am I Bleeding During Sex?
One of the most common causes of postcoital bleeding is vaginal trauma or laceration when the vaginal wall becomes stretched, damaged or torn during intercourse or foreplay.
Vaginal tears can result from unusually rigorous sex, vaginal dryness caused by low estrogen levels (during menopause or breastfeeding) or if a penis or sex toy is inserted too forcefully. While they're tiny, these tears should be taken seriously as they could also lead to infection.
"Bleeding after sex can be due to the sex itself, particularly if it's on the vigorous side or there is not enough lubrication, causing friction," says Dr. Fran Yarlett, GP and Medical Director at thelowdown.com, the UK's leading reproductive and sexual health platform. "It can also be the sign of an underlying problem; however, this is rare, and you will usually experience other symptoms such as pain and persistent bleeding."
Is Bleeding During Sex Normal?
The term "normal" is subjective. Bleeding may happen, but it is always a sign that the body needs more support. This can be due to either an underlying condition or a lack of lubrication -- neither of which should be ignored.
"In some cases, bleeding after sex can signify something more serious," Dr. Yarlett continues, "If you have other symptoms besides bleeding, such as pain during sex or pelvic pain, you should see a medical professional."
Is Bleeding During Sex a Sign of Pregnancy?
Bleeding during or after sex isn't uncommon in early pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), a little spotting is typical and tends to happen the first two weeks after fertilization.
"Implantation bleeding can happen when a fertilized egg attaches to the uterus," says Evie Plumb, Here We Flo's ACET-qualified sex educator and the founder of Cliterally the Best, a sex-positive educational platform and podcast, "It usually happens around the time of your menstrual cycle."
Many people may also experience cervical bleeding during pregnancy, which may result in spotting after sex, a Pap test or a pelvic exam.
READ: 3 Great Sex Positions for A Tilted Cervix
"Yes, having sex during pregnancy can cause bleeding. This is because the cervix is sensitive during pregnancy, but light spotting is common during early pregnancy," Plumb continues. "That being said, if you have any bleeding from your vagina, you should always contact your GP to be on the safe side."
Potential Causes of Bleeding During Sex
In some cases, bleeding during or after sex could indicate an underlying problem. Common causes of vaginal bleeding after sex include:
Pelvic inflammatory disease (PID), vaginitis, cervicitis and sexually transmitted infections (STIs), including gonorrhea and chlamydia, can cause postcoital bleeding.
“There’s a chance that a sexually transmitted infection is to blame for bleeding during sex,” says certified sex therapist Aliyah Moore, Ph.D., “Open sores from genital herpes and syphilis can bleed when agitated; these sores often form on the outside, but occasionally they can form inside the vagina and go undetected until they bleed.” Moore continues: “Chlamydia and gonorrhea also closely correlate with vaginal symptoms such as vaginal discharge, itchiness, pelvic discomfort and bleeding.”
Endometriosis is a chronic and inflammatory condition in which endometrial-like tissue grows outside the uterus. This abnormal tissue growth (which can develop anywhere in the body) can lead to scarring and adhesions.
Common symptoms of endometriosis include, but are not limited to:
- pain during sex
- postcoital bleeding
- excruciating cramping and heavy menstrual bleeding
- spotting or bleeding between periods
READ: Masturbation 101: A Guide for People With Endometriosis
Vaginal dryness occurs when the lining of the vagina becomes thin, dry and inflamed. This is usually due to a loss of estrogen.
“Women who have entered menopause tend to bleed more often during or after sexual activity,” says Moore. “As you age, your body tends to generate fewer estrogen hormones. This can cause thinner walls and a decrease in cervical mucus production. As a result, vaginal tearing becomes more common.”
Other causes of vaginal dryness include:
- chemotherapy and radiation therapy
- having intercourse before you’re fully aroused
- certain feminine hygiene products
- certain medications (e.g., anti-estrogen drugs, asthma medications, some antidepressants, and cold medication)
READ: Vaginal Dryness: What to Do When Natural Lubrication Isn't Enough.
Bleeding after sex is a common symptom of cervical and uterine cancers. According to one 2021 literature review, approximately 3.8% of people with postcoital bleeding have cervical cancer.
Other symptoms that are typically associated with cancer of the reproductive system include:
- heavy or prolonged periods
- bleeding after menopause or bleeding between periods
- bloody vaginal discharge
When to See a Doctor
Bleeding during or after sex isn’t usually a cause for concern, especially if it's light-red or pinkish and goes away within a few hours after intercourse.
If you have other symptoms besides bleeding, such as pain during sex, abnormal vaginal discharge or pelvic pain, you should make an appointment with your GP or OB-GYN.
Tabitha Britt is the founding editor-in-chief of DO YOU ENDO, a digital magazine for individuals with endometriosis by individuals with endometriosis.