Julie Medical Advisor
Is bleeding after sex normal?
Seeing blood on the sheets or on yourself after sex can be shocking. Especially if you know it’s not time for your period. But bleeding after sex isn’t always something to worry about. It’s actually pretty common, and there are several causes for it. Also referred to as postcoital bleeding, this type of vaginal bleeding, unrelated to your menstrual cycle, looks like spotting or regular bleeding after sexual intercourse. It affects up to 9% of menstruating women. Even though blood after sex isn’t always cause for alarm, the frequency and amount of blood you see could be signs of a more serious underlying health condition. In this article, we’ll cover the causes that lead to bleeding after sex and when it’s time to see your healthcare provider.
When is bleeding after sex normal or a sign that something is wrong?
Bleeding after sex can be common and harmless, especially when caused by friction during sex, your hymen breaking, or vaginal dryness. In these instances, you can try more gentle intercourse, increasing foreplay (to create natural lubrication) or using a lubricant.
Sometimes bleeding after sex can be a sign of inflammation, which can be caused by a sexually-transmitted infection (STI). If you think you might have an STI, get tested as soon as possible. The sooner you get tested and start treatment, if needed, the less harm the STI can cause to you and your partner.
What causes bleeding after sex?
Most of the time, postcoital bleeding is no cause for alarm. However, the causes range from normal to serious, so it’s important to see a medical provider if you have specific concerns or if you find that you’re frequently bleeding after sex.
Here are some of the most common causes:
First-time hymen breaking
The ‘hymen’ is a fleshy mucosal tissue that surrounds the vaginal opening. It’s formed during development and is present at birth. Over time, this tissue thins and stretches. For some people this happens without them knowing. For others, the first time (or even the first few times) of penetrative sex causes the hymen to tear and bleed.
Some people might feel pain when the hymen tears; other people won’t feel it all. This can look like spotting or bleeding. The bleeding should resolve after 24 hours and the tear will heal. However, if someone has penetrative sex again before the tissue has completely healed, they may experience bleeding again. This is normal and is not cause for concern. But if the bleeding is heavy or prolonged, it’s best to see a doctor.
Inflammation & Infections
Inflammation of the cervix, called cervicitis, can cause bleeding after sex or a change in vaginal discharge. It’s usually the result of an infection or irritation. Inflammation can result from STIs, such as chlamydia, gonorrhea, or trichomoniasis. STIs are contagious but many can be treated with medication. Pelvic inflammatory disease (PID), when an STI has spread to the reproductive organs, can also cause bleeding after sex. If you think you or your partner might have an STI, read more about what to do here.
Cervicitis can also be caused by HPV (the human papillomavirus) which is the main cause of cervical cancer. HPV infection of the cervix can cause frequent postcoital bleeding. This is monitored during routine pap smears, but if you notice bleeding repeatedly after penetrative sex you should discuss with a doctor.
Irritation that leads to bleeding could also be a possibility, which can be caused by chemical irritation from spermicides, douching, or latex condoms. If symptoms do not resolve after 24 hours it’s best to see a doctor.
Vaginal dryness
Vaginal dryness occurs when there isn’t enough lubrication during penetrative sex. This causes friction that leads to small tears in the vaginal wall and bleeding after sex. A natural lack of lubrication can be caused by a variety of factors which include not being fully aroused before sex, low estrogen (as happens around menopause and when breastfeeding), or certain medications.
Some people find that engaging in foreplay prior to penetration can increase production of natural vaginal lubrication. Another solution is using OTC lubricants. There are three basic types of lubricants (water, oil and silicone) and can all help with vaginal dryness. However, you should never use oil-based lube with condoms as it can cause tears or breaks in the condom.
Cancer
Though less common, frequent bleeding after sex can be a symptom of cervical or vaginal cancer. Cervical cancer occurs in the cervix, the lower part of the uterus that opens into the vagina, and is caused by HPV. Around 11% of people who have cervical cancer experience postcoital bleeding. Endometrial cancer, a cancer that starts in the uterus, can sometimes be diagnosed at an early stage because of frequent and abnormal vaginal bleeding. Vaginal cancer can also cause bleeding to occur after sex.
Vaginitis
Vaginitis, or vulvovaginitis, is the inflammation of the vulva and vagina. Similar to cervical inflammation, this inflammation can also cause postcoital bleeding. It’s often due to infection or irritation.
Treatment
Since bleeding after sex can be caused by a variety of different factors, there’s no one-size fits all treatment.
To prevent bleeding, there are a few things you can try. First, try taking a break from penetrative sex for a few days to give your body time to heal. You can also try using a lubricant or engaging in more foreplay before moving onto intercourse. This can help you be more aroused and lubricated when you do have penetrative sex. Gentle, less aggressive sex can also help stop any bleeding that might be caused by too much friction. Take it slow, and if you begin to feel pain, let your partner know and take a break.
To truly stop bleeding after sex, you need to figure out what’s causing it:
- Vaginal dryness: Lubricants can help to ease the dryness that leads to friction and bleeding. If vaginal dryness is caused by hormonal changes, a doctor can recommend topical medications.
- STIs: The best way to find out if you have an STI is to get tested. If you have an STI, your medical provider can make recommendations to treat or manage your infection.
- Cervical cancer: Pap smears are performed by a gynecologist or family medicine doctor beginning at the age of 21. The purpose of pap smears is to detect if you have HPV or signs of early cervical cancer. If detected early enough, your doctor may recommend more frequent pap smears or may remove the affected cells. If the cancer is more developed, treatment can involve surgery, chemotherapy, cryotherapy, or radiation. While cervical cancer is often treatable, it’s best to stay up to date on pap smears and to discuss frequent postcoital bleeding with a doctor as soon as possible.
When to see a doctor
Though bleeding after sex isn’t always cause for concern, be sure to see a doctor if bleeding hasn’t stopped after 24 hours. If you’re unsure about how much you’re bleeding, you can use a pad to help measure the amount of blood. If the bleeding is accompanied by pain or fever, or if the bleeding is heavier than normal, it’s always best to get it checked out.
Although the information above may be useful, it shouldn’t replace the advice of your healthcare professional. For questions about birth control and other women’s health issues, please talk to your healthcare professional.
Emergency contraceptives like Julie work when you take them after sex. That’s because emergency contraception prevents pregnancy by delaying when you ovulate. By taking emergency contraception before sex, you may not be delaying ovulation long enough.
No. Julie is not what is commonly called “the abortion pill” or “medication abortion”. The active ingredient in the abortion pill is mifepristone. Pregnancy needs a hormone called progesterone to grow normally. Mifepristone blocks your body’s own progesterone, stopping the pregnancy from growing. Julie does not and will not impact an existing pregnancy, and works by delaying ovulation before there is a pregnancy.
The FDA recently made an update in December 2022 to remove any language suggesting that Julie may prevent implantation of a fertilized egg. We are currently working on removing this outdated disclaimer but you may still see it present on some of our packaging in the meantime. Please disregard these statements because they are out of date. Julie will not impact an existing pregnancy.
Julie is an emergency contraception you can take after:
- You didn’t use any form of birth control or had unprotected sex
- There was an issue with your regular birth control method (eg, the condom broke or slipped)
- You missed a dose (or more) of your regular birth control pill
Taking Julie will not impact your ability to get pregnant.
After taking Julie you can continue on with your regular birth control method if you have one (for example, continue taking birth control pills).
You will know Julie has been effective when you get your next period, which should come at the expected time, or within a week of the expected time. If your period is delayed beyond 1 week, it is possible you may be pregnant. You should get a pregnancy test and follow up with your healthcare professional.
Julie is a backup or emergency method and should not be used as a regular birth control method. Consult with your doctor about a birth control method that makes sense for you.
Please know that taking a dose of Julie will only protect you from one instance of unprotected sex, it will not prevent pregnancy from unprotected sex over the coming days or weeks. If you have unprotected sex in the future and want to prevent pregnancy, be sure to take a new dose of Julie and talk to your doctor about the best birth control options for you.
Your menstrual bleeding patterns may change temporarily after using levonorgestrel. If you find that your period is more than a week late, take a pregnancy test to confirm whether the contraceptive has worked.
Julie can be used by all women, regardless of weight but women with BMIs above 29.9 have a pregnancy risk of 5.8% - meaning that out of every 100 women who take Julie, 6 may become pregnant. We advise that you speak with your doctor for further information on how this may affect you personally.
Take Julie tablets orally (swallow it). It is preferable to take it with water, and you can take it with or without food. Do not insert Julie vaginally.
Julie is not an abortion pill and will not harm an existing pregnancy nor will it be effective if a woman is already pregnant.
Julie is a progestin‑only emergency contraception product that helps prevent pregnancy before it starts when taken within 72 hours after unprotected sex.
Julie is a backup method of preventing pregnancy and should not be used as regular birth control. Use as directed.
Julie is effective up to 72 hours (3 days) after unprotected sex. The sooner it’s taken after unprotected sex, the better it works.
Julie can significantly decrease your chances of getting pregnant. When used as directed, about 7 out of every 8 women who could have gotten pregnant will not become pregnant after taking Julie. The most important factor affecting how well Julie works is how quickly it is taken. When taken as directed within 72 hours after unprotected sex or birth control failure, Julie can significantly decrease the chance that a woman will get pregnant. In fact, the earlier Julie is taken after unprotected intercourse, the better it works.
Emergency contraception is not 100% effective, which is why it is critical that women have a regular birth control method. If you have any further questions, we encourage you to talk to your healthcare provider.
Since emergency contraception can affect the length of your menstrual cycle, your period might come about a week later or earlier than usual after taking Julie. If your period is more than one week late, consider the possibility of pregnancy.
No. No one needs a prescription to purchase Julie or EC. However, some insurances require a prescription for reimbursement. Some pharmacies and places where EC is sold may tell you that you need a prescription. You do not.
You do not need to see a doctor before or after taking Julie. You do not need a prescription from a doctor. We do encourage you to speak to a doctor you feel comfortable with about sex, reproductive health, and contraception.
No. We know this is a common misconception so let’s break it down. Using Julie (no matter how many times you take it) does not affect your fertility — and it will not prevent you from becoming pregnant in the future. You should feel free to use Julie whenever you think it’s necessary. Julie (and all EC) is not recommended as an ongoing form of birth control because it’s not as effective at preventing pregnancy as birth control methods like the IUD, patch, pill, ring, or shot. Also, frequent use of EC may cause periods to become irregular and unpredictable. That’s it!
Yes. You are not alone. Often times, people who buy EC are feeling stressed out, concerned, embarrassed, confused or ashamed. The important thing to remember is that you are not alone, you have nothing to be ashamed about, and the Julie community is here to support you. By taking Julie after unprotected sex, you are taking control of your future and taking a safe, effective, approved method of preventing pregnancy.
