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.