We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions will remain anonymous. Please send your questions to firstname.lastname@example.org. This week’s topic: reasons you may be bleeding during or after sex.
Q: Sometimes after I’m done having sex, I notice that I’m bleeding a little out of my vagina. It’s not when I’m having period sex. Just regular times. It’s not, like, gushing, but there’s definitely blood when I wipe myself after sex and sometimes I even notice a bit of blood on my boyfriend’s condom. I haven’t gone to the doctor because the bleeding doesn’t continue, but last night I started freaking out a bit that maybe I’m actually in danger, or I'm having sex too hard. Could this be medically significant? No one ever told me about bleeding after sex.
A: While we don’t talk about it in sex ed class for some reason, bleeding during or after sex (particularly penis-in-vagina penetrative sex) is relatively common. Your vagina, while a total badass that can squeeze out a tiny human all by itself, is also made of pretty tender material. It’s sensitive up in there, which is a big part of why it feels so good to have sex. But it also means that when it’s banged around, there can be a bit of blood. Your vaginal canal is also connected to a bunch of other delicate and complex areas, and disruption of those can result in some bleeding.
The important thing to know is that there are a bunch of reasons why you could be noticing some blood after a sexy romp. Many of these aren't necessarily serious, but to know the underlying cause of the bleeding, you have to visit your doctor.
"Bleeding after sex is not normal and should always be evaluated," Dr. Natalya Danilyants, a laparoscopic GYN surgeon and co-founder of The Center for Innovative GYN Care, tells Bustle. But it's important to approach your OB/GYN visit with a cool head.
"If one has one episode of post-coital bleeding and never has another, it's unlikely to be anything evil," Dr. Mary Jane Minkin, a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine, tells Bustle. For multiple episodes of bleeding after sex, Dr. Minkin suggests seeing your gynecologist for an exam, cultures, and a Pap smear.
So let’s get to it. Why might you be experiencing post-sex bleeding?
1. It's Actually Just Your Period
This may seem obvious, but sometimes when you notice blood in your vagina, it’s just because you’re on your period. It could be the start of your period, so the blood is unexpected, or it could be a bit afterwards, when you thought you were done but lo and behold — there’s still more left inside! This is totally normal and there’s not much you can do about it, other than putting in a vaginal sponge if you are really squidged out by having period blood included in your sexual experience.
2. You're Having Sex For The First Time
It's commonly believed that the first time you have penis-in-vagina sex, you will bleed because your hymen, a thin membrane up in there, will break (thereby "popping your cherry"). This is actually a misconception, because your hymen wears away naturally over time. This means there's also a big chance you won't bleed at all your first time — depending on how old you are when you start having penetrative sex and what else you've been up to in your life (like if you've ever used a tampon, for example).
It is true that if you start having sex when your hymen hasn't worn away yet, it can tear and you may bleed a bit. Remember that for the vast majority of people, the hymen always has a hole in it — that's how menstrual fluid and vaginal discharge get through!
3. There's Not Enough Lubrication
Vaginas are self-lubricating, it’s true. However, not everyone makes enough of their own natural lube to make sex slippery enough to feel great — or protect your delicate vaginal membranes.
"The vaginal and vulvar tissue is the most sensitive tissue in the body," says Dr. Minkin. It’s important to have enough lubrication in your vagina to protect your skin, so it doesn’t get chafed by the in-and-out friction you’re generating. Friction can result in tiny tears, which in turn can result in blood.
If you don’t make enough lubrication on your own (everyone’s different, and some people are different day-to-day, based on their menstrual cycle, how they’re feeling that moment, you name it) you can always add some store-bought personal lubrication into the mix. It’s also good to remember that vaginas often take a bit of time to get going — so don’t forget foreplay!
4. Vaginitis Or Cervicitis
These words both sound kinda stressful, but "-itis" just means the word it’s modifying is inflamed or infected. So vaginitis is inflammation or infection of the vagina, and cervicitis is inflammation or infection of the cervix. This can cause changes in vaginal discharge, itching, and pain (for vaginitis), and changes in vaginal discharge and bleeding (for cervicitis). Both can cause bleeding after sex, says Dr. Danilyants.
Causes can include bacterial infection (such as an STI) but also just normal changes in your body during your period or as you age. To figure out the culprit for your vaginitis or cervicitis, should you have either, you’ll need to work with your doctor.
5. An STI
Some sexually transmitted infections (STIs) have the side effect of potential vaginal bleeding after sex — along with other symptoms. Some STIs "cause bleeding by creating inflammation/irritation of the cervix and uterus," says Dr. Danilyants, pointing to herpes, gonorrhea, chlamydia, and trichomoniasis as possible culprits. Chlamydia and gonorrhea are bacterial infections that impact the cervix, causing bleeding as well as other unpleasant side effects such as itching, burning, changes to your vaginal discharge, and pelvic pain. If you have one of these infections, you can get antibiotics from your doctor to get cured, which should do away with the bleeding.
Trichomoniasis infection can lead to vaginitis, which as we now know can cause vaginal bleeding during sex. Trichomoniasis is easily cleared up with an antibiotic, so if you notice that in addition to postcoital bleeding your vagina is itchy, it hurts when you pee, and your discharge is smelly, frothy, foaming, and either yellow or gray-green, talk to your doctor to get tested.
6. Low Estrogen
Low estrogen can cause a host of physical and emotional challenges, one of which is bleeding during sex, Dr. Minkin told Bustle for a previous article. This happens because estrogen helps keep your vagina walls thick, and increases your ability to self-lubricate. Low estrogen, which can happen if you change birth controls or if you're premenopausal, can result in thinner vaginal walls and vaginal dryness. These set up conditions for potential inflammation or infection — and in turn, can result in vaginal bleeding during sex.
Endometriosis is a condition wherein the lining of your uterus (called your endometrium) grows outside your uterus. This is problematic because these cells still act like endometrial cells, meaning they shed during your period — only, since they're outside your uterus, they don't have anywhere to go, which can result in pain. When these uterine cells jump ship and attach to the cervix or vagina, they can bleed during sex.
Endometriosis is not the easiest condition to treat, or even know you have. Fortunately, there's been much more awareness of the condition in the last few years, so many more doctors are informed about the options to manage it, which can include pain medication, birth control, or surgery.
8. Cervical Ectropion
Cervical ectropion, also called cervical erosion, is when the cells that are normally inside the lining of your cervix poke out around the cervical opening, according to the UK's National Health Service (NHS). These cells were designed to be protected inside your cervix, so when they are outside in the great big world of your vagina, they can get inflamed and may bleed more easily.
This cervical cell situation is most often dealt with by adolescents, folks on oral birth control, or people who are pregnant. Fortunately, it's not linked to cervical cancer.
9. A Benign Growth
We tend to think of any growth that’s not supposed to be in our bodies as something really scary, but many growths are not cancerous and are often just annoying. You can get these benign polyps on your cervix or uterus, and these can cause bleeding during sex because they are fragile little things that bleed when touched, says Dr. Danilyants. Polyps can go away on their own, but sometimes they have to be removed with surgery. Luckily, this removal is easy and painless in most cases.
10. Cervical Dysplasia
Cervical dysplasia is what doctors call precancerous changes to the cells inside your cervix. This is what Pap smears are looking for when you get them every couple of years. Postcoital bleeding is one outward sign of these cell changes; if you are diagnosed with the strains of HPV that are linked to cancer, you may know to be on the lookout for this Pap result. These precancerous cell changes can be treated before they become cancerous with a quick surgical procedure, says Johns Hopkins Medicine.
Bleeding after sex can also be an indication of cervical or uterine cancer, says Dr. Danilyants. This is by no means the first culprit your mind should jump to when you notice a bit of blood on your sheets after sex — only around 13,000 people were diagnosed with cervical cancer in 2018, says the American Cancer Society — but it is a potential cause.
This is why if bleeding during or after sex is common for you, you’ll need to go to your doctor. They will do a number of tests to see if you have cancerous cells or rule out these conditions.
The Bottom Line
There are so many reasons why you might be experiencing a bit of blood during or after sex. In most cases, the reason isn’t scary, and the bleeding will often go away on its own. But it's important to always check in with your doctor just in case something more serious is going on.
Additional reporting by Eden Lichterman
Dr. Natalya Danilyants, MD, laparoscopic GYN surgeon and co-founder of The Center for Innovative GYN Care
Dr. Mary Jane Minkin, MD, a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine
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