Bleeding after sex is also known as post-coital bleeding. At one point or another, many women have experienced bleeding after sex. Upto 63% of women in the post-menopausal age group have experienced vaginal dryness or post-coital bleeding and around 9% of women in the menstruating age group have complaints of post-coital bleeding. If someone has post-coital bleeding, it is better to consult a gynaecologist.

Causes of Post-Coital Bleeding

In women who haven’t reached menopause yet, the source of bleeding is usually the cervix. However, in post-menopausal women, the source could be the cervix, uterus, labia or the urethra.

Infections

Some infections can cause inflammation of the vaginal or cervical tissue causing bleeding. These include:

Pelvic inflammatory disease (PID): PID is an infection involving the female reproductive organs, namely the uterus, cervix, fallopian tubes or ovaries. This can be caused by bacteria or even certain sexually transmitted infections such as gonorrhoea and chlamydia.
Sexually transmitted diseases (STDs): STDs may not show symptoms, but still cause damage to your body. These can increase the risk of infertility, transmission to sexual partners or unborn babies, and increase chances of contracting HIV.
Cervicitis: Inflammation of the cervix, known as cervicitis can cause symptoms such as bleeding, discharge or pain. It is caused by sexually transmitted infections or due to sensitivity to chemicals in tampons or lubricants.
Vaginitis: Vaginitis or vulvovaginitis is a common condition due to inflammation of the vagina. It can be caused by bacteria, yeast, sensitivity to certain chemicals or irritants or due to poor hygiene.

Genito-Urinary Syndrome of Menopause

This was earlier known as vaginal atrophy. This condition is seen in perimenopausal and menopausal women. In this phase of your life, or after you have had your ovaries removed, your body stops producing oestrogen. Oestrogen is responsible for regulating the reproductive system. Lower oestrogen levels can lead to vaginal dryness and inflammation. Moreover, the elasticity of the vaginal walls also gets reduced. This leads to pain and bleeding during sex.

Vaginal dryness

This can occur in the post-menopausal phase as well as due to factors like childbirth, breastfeeding, chemotherapy or radiotherapy, chemicals in detergents or sanitary pads.

Polyps

Polyps are small out-growths that commonly arise in the vagina or cervix. Due to movement, they can lead to irritation of blood vessels and bleeding.

Vaginal tear

Rough or vigorous sex can lead to tears or scrapes in the vagina. This is more likely when there is vaginal dryness or in menopausal women.

Cancer

Irregular vaginal bleeding is often the first symptom in women with cervical or vaginal cancer. Upto 11% of the women diagnosed with cervical or vaginal cancer present with irregular bleeding. Post-menopausal bleeding is also a sign of uterine carcinoma. These cancers are more common in women over the age of fifty or post-menopause. In addition to age, other risk factors for uterine cancer include being overweight. Cervical cancer has risk factors like taking birth control pills for over 5 years or having a human papillomavirus (HPV) infection.

Red flag symptoms associated with post-coital bleeding

If you are not post-menopausal, do not have any other risk factors, and have experienced only occasional spotting, you do not need to see your doctor immediately unless you have symptoms such as:

Vaginal itching or burning which is a sign of infection
Burning or stinging sensation when urinating
Heavy bleeding
Severe abdominal pain
Pain in the lower back
Nausea or vomiting
Unusual vaginal discharge

Identifying the cause for post-coital bleeding

The treating gynaecologist will order a cervical pap smear test. This is a form of exfoliative cytology, where a brush or spatula is inserted into the vagina to collect the cervical cells from the surface of cervix and look for malignant or premalignant changes.

Other tests that can be done are:

A colposcopic examination of the cervix and vagina to look for any abnormal areas.
A transvaginal ultrasound to look for any growths
Urine examination to rule out a urinary tract infection
Blood tests
Microscopic examination of vaginal discharge

Treating post-coital bleeding

Treating vaginal bleeding will depend on the cause. If cancer is ruled out then

Lubricants

To treat vaginal dryness, vaginal moisturizers can be applied regularly to reduce dryness and also restore the acidity of the vagina.

Oestrogen therapy

Vaginal dryness due to natural menopause or due to the removal of ovaries can be treated by administering oestrogen. Topical oestrogen can be applied either in the form of a cream or as a suppository. Oral hormone therapy is also given for menopausal women to battle all problems associated with it.

Other treatment options

Vaginal infection can be due to yeast or bacteria. This is treated by appropriate medications.