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.
Some infections can cause inflammation of the vaginal or cervical tissue causing bleeding. These include:
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.
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 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.
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.
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:
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:
Treating post-coital bleeding
Treating vaginal bleeding will depend on the cause. If cancer is ruled out then
To treat vaginal dryness, vaginal moisturizers can be applied regularly to reduce dryness and also restore the acidity of the vagina.
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.
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