Reasons You're Bleeding After Sex
Picture it: You've just had sex. Your glow starts to fade when you notice something on your pristine white bedsheets. Is that blood? You're not on your period, so why is there blood? What is causing you to bleed after sex?
Is it your hymen?
If this is your first time having penetrative intercourse, there is a chance the blood could be from the breaking or tearing of your hymen, the membranous tissue at the opening of the vagina.
However, hymens don't always "break" during sex, said Thais Aliabadi, M.D., a board-certified OB-GYN and founder of Trimly, a weight-loss program based in Los Angeles.
"The hymen is not like a seal on a drink…Some will 'break' with first penetrative intercourse and some won't. Some will break before or outside of intercourse. The state of the hymen is not evidence of sexual activity or lack thereof," said Wendy Goodall McDonald, M.D., a board-certified OB-GYN at Women's Health Consulting in Chicago.
It's important to note, not everyone bleeds after their first time engaging in penetrative intercourse. Some vaginas will bleed during the first time having penetrative intercourse due to the hymen being stretched or torn, explained Jerome Chelliah, M.D., Master of Public Health (MPH), board-certified OB-GYN and Vice President of Clinical Operations at HerMD, who practices out of Clevland, Ohio.
What else causes bleeding after sex?
There are many other reasons you might be bleeding after sex. The most common causes are pelvic inflammatory disease (PID) or a sexually transmitted infection (STI) such as chlamydia, Chelliah said.
Other causes that might explain why you are bleeding during sex include: atrophic vaginitis, which is vaginal dryness that results from reduced vaginal secretions, typically after menopause; damage to the vagina, such as tears caused during sex; cervical or endometrial polyps; cervical ectropion; and, rarely, cancer, Chelliah explained.
PID symptoms and treatment
PID is an infection of the female reproductive tract that is often caused by untreated chlamydia or gonorrhea. In addition to bleeding after sex, other symptoms of PID include cervical tenderness, abdominal pain and fever.
PID can be treated with antibiotics, Chelliah said.
Chlamydia symptoms and treatment
Chlamydia is a type of STI caused by bacteria and can be transmitted through oral or penetrative sex or contact with infected genital fluids. Bleeding after sex is one symptom, but chlamydia is often asymptomatic. A physical exam could reveal an inflamed cervix caused by this STI.
Similar to PID, chlamydia can be treated with antibiotics, Chelliah said.
Atrophic vaginitis symptoms and treatment
Atrophic vaginitis typically happens after menopause and presents vaginal dryness due to the decrease of vaginal secretions during this time.
It is diagnosed by an exam which would show a loss of vaginal rugae (folds or ridges in the vaginal walls), and is treated with estrogen cream, Chelliah said.
Cervical ectropion and cervical/endometrial polyps symptoms and treatment
"Cervical and endometrial polyps are benign outgrowths within the uterus or cervix. Cervical ectropion is when the cells inside of your cervix are exposed to the outer aspect of your cervix, resulting in friability of the cervix," Chelliah explained.
If you have cervical ectropion, in addition to bleeding after penetrative intercourse, you may find yourself bleeding with exercise, or you may have no other symptoms and it would be seen in a physical exam.
Cervical and endometrial polyps might not show any other symptoms and may be visible only on an exam or ultrasound. As for treatment, cervical ectropion is usually managed expectantly or monitored, while cervical or endometrial polyps can be removed hysteroscopically, Chelliah explained.
Vaginal tears symptoms and treatment
Tears in the vagina from penetrative intercourse could cause bleeding during sex. Vaginal tears can be diagnosed by an exam that would show these lacerations.
Vaginal tearing can be reduced by the proper use of lubricants and can be repaired in surgery with sutures, which hold the body tissue together, Chelliah said.
Cancer symptoms and treatment
"It is hard to differentiate [cancer] until a physical exam. However, advanced stage cancers could come with weight loss, fatigue or symptoms associated with areas of metastasis," Chelliah said.
If you are bleeding during sex because of advanced-stage cervical or vaginal cancer, this would be seen by the presence of a protruding mass on a pelvic exam.
"Cancer will be managed depending on the stage, ranging from surgery to chemoradiation," Chelliah explained.
Can sex jump-start your period?
If you are bleeding after penetrative intercourse and your period is around the corner, there is a chance the sex you just had did somewhat jump-start your period, especially if you orgasmed.
"If you orgasm during sex, the orgasm can cause uterine contractions. If you are within a few days of the anticipated start of your period, an orgasm can cause menstrual blood to be expelled as a result of uterine contractions," Chelliah said.
However, if you orgasm during sex and your period is not expected to start any time soon, penetrative intercourse will not jump-start your period, Chelliah explained.
What is the treatment for bleeding after sex?
Treatment for bleeding after sex depends on the cause of the bleeding.
"If the bleeding is from an infection or an STI, antibiotics will serve as the first line of treatment. If the bleeding is caused by a polyp, then removal of the polyp is generally necessary," Chelliah said. "If a tear is causing the bleeding, it should be repaired. In the unlikely event cancer is causing the bleeding, an oncologist will manage your treatment options.
Chelliah added that you should be evaluated by a medical provider if the bleeding is persistent, occurring each time you have sex, or heavy, which is defined as soaking through one pad every hour.