Why Do I Bleed After Sex?

You’re basking in the afterglow of amazing sex with your partner, and you notice some spotting on the sheets. You’re not expecting your period, so why is there blood? Seeing pink, red, or brown discharge after sex – known as post-coital bleeding – can be alarming but it might not be anything to worry about. Here’s a guide to why you might bleed after sex.

Is it Normal to Bleed a Little After Sex?

Bleeding after sex is surprisingly common. It might be immediately after sex or even a day or two later. Although it’s generally referred to as vaginal bleeding, most times the blood is from the cervix, the fleshy end of the uterus at the top of the vagina. Infrequent bleeding after intercourse is probably fine, but you should mention it to your doctor if you have frequent post-coital bleeding, especially if it’s been a while since you had a pap smear and pelvic exam.

What Causes Bleeding After Intercourse?

Some of the causes of post-coital bleeding are completely benign, others are merely irritating, and others may be a sign of a more serious underlying health problem, such as endometriosis, PCOS, a sexually transmitted infection, or, in rarer cases, cancer. As your body changes due to monthly hormone cycles, pregnancy, or heading into perimenopause and after, the reasons you may bleed after sex also change.

Penetrative Sex and Post-Coital Bleeding

The hymen, a thin piece of tissue around your vaginal opening, can stretch the first time (or few) that you have sex and cause some bleeding, but you can also bleed after sex well beyond losing your virginity.

The cervix has many blood vessels and can be disturbed during sex. Some sex positions put more pressure on the cervix, and your partner’s size can also play a role. It's not uncommon for the cervix to bleed slightly after it’s been moved or pushed on – which can feel really good during sex for some people. During arousal, the vagina and cervix swell, making the blood vessels fuller and more sensitive, which can also increase the chance for light bleeding.

Deeper, rougher, or longer-lasting penetrative sex can also cause minor tearing of the vaginal walls, leading to some post-coital spotting. If you’re not as aroused and your vagina is drier, bleeding can be more likely. Take care when inserting fingers or sex toys into the vagina as well, as fingernails and edges can also cause bleeding.

Using lube can help increase vaginal lubrication and reduce the chances for this type of bleeding after sex. Be sure to use a water-based lube when using a condom or silicone sex toy; otherwise, a silicone-based lubricant tends to last the longest.

Bleeding after Intercourse from an IUD or an Exam

As we learned above, anytime the cervix is disturbed there is a chance for some light bleeding. Pelvic exams and inserting an IUD for birth control can cause some spotting for a day or two after. Hormonal IUDs can also cause some light bleeding for the first few months while your body adjusts, including after sex.

Your uterus – where the IUD sits – contracts during sex and orgasm, which creates pleasure as well as the chance for some spotting. Pay attention to what your doctor says is normal for bleeding with an IUD and if something changes or you’re concerned, make an appointment to make sure the IUD is still in place properly.

Light Post-Sex Bleeding During Pregnancy

When you’re pregnant, the hormones and changes in your body, uterus, and vagina can increase the chances for light bleeding after sex. Your cervix becomes even more sensitive during pregnancy and can bleed more easily, especially in the first trimester. In the final trimester, your cervix begins to thin and prepare for delivery and may also be more prone to bleeding.

Light, short-lived, painless spotting after sex is typically fine, as is having sex during pregnancy, but always listen to your body and your doctor’s advice.

Vaginal Infection, STIs and Bleeding After Sex

Bleeding after sex often comes from cervicitis, or inflammation of the cervix. Your cervix can become inflamed from time to time for the reasons we’ve discussed above, but also from a cervical or vaginal infection. STDs such as chlamydia, gonorrhea, and Pelvic Inflammatory Disease (PID) all cause cervicitis and can cause pain and bleeding after sex. So can genital sores caused by herpes or HPV.

Head to your doctor for a Sexually Transmitted Infection screening to make sure an STI or another type of infection isn’t the root of your post-coital bleeding, especially if you also have other symptoms such as pain, itching, burning, or foul odor.

Yeast infections can also cause vaginal bleeding after sex due to inflammation of the vagina and changes in your discharge. See your doctor if you’re experiencing the itching, burning and thick white discharge that can indicate a yeast infection.

PCOS, Cervical Polyps, Endometriosis and Post-Coital Spotting

Cervical polyps are small, 1-2 centimeter growths on the cervix that are usually non-cancerous. Your doctor will remove the polyps (a polypectomy) during your annual exam if any are discovered. Some polyps bleed occasionally, especially after intercourse.

Cysts on your ovaries can cause light bleeding when they rupture, such as when you ovulate or additional cysts that can form. If you have PCOS, you may experience more post-coital bleeding due to the increased cysts and menstrual irregularity this hormone imbalance can cause.

People with uterine fibroids and/or endometriosis can be more prone to bleeding after sex as well. Penetrative sex can irritate already sensitive uterine tissue. Try switching positions so you can control the depth of penetration or asking your partner to go slower.

Rarely, bleeding after sex is caused by cervical or ovarian cancer. Maintain regular checkups with your ob/gyn so you can be screened for early signs of cancers of the ovaries, cervix, or uterus.

Menopause, Hysterectomy, Vaginal Atrophy and Bleeding After Intercourse

As you enter the years before menopause (known as perimenopause) or enter forced menopause after a hysterectomy with ovary removal, your levels of estrogen drop, leading to vaginal dryness and atrophy. Your vaginal walls change and can be more prone to bleeding after sex.

Your doctor can prescribe a vaginal estrogen cream, or you can try over-the-counter estrogen-free solutions such as Replens™ Long Lasting Vaginal Moisturizer or Replens™ Silky Smooth Silicone-Based Lubricant to supplement your body’s natural lubrication. It’s also a good idea to use a lubricant before sex to make it more comfortable and help reduce the friction or chafing that can lead to post-coital bleeding.

If you’re post-menopausal (it’s been a full 12 months without a period) and you experience bleeding after sex or otherwise, make an appointment with your doctor for an exam.

Pink or Brown Discharge After Sex That’s Not Your Period

Sometimes, bleeding after sex is leftover blood from your menstrual period. When you orgasm, your uterus contracts and that can push some pink- or brown-tinged discharge through the cervix into the vagina. Brown discharge has older blood in it, while pink or red has brighter, new blood. Learn more in our guide to vaginal discharge colors and what they may mean.

If you’ve just finished your cycle or you’re about to, the post-coital bleeding may simply be menstrual blood being expelled. If it’s at the mid-point of your cycle and you’re not using birth control, vaginal bleeding after sex might be implantation bleeding, or when the fertilized egg attaches to the uterus wall. If you’re not sure or if you’re having other early signs of pregnancy, take an at-home pregnancy test.

Medications and Post-Coital Bleeding

If you’re taking medicine for high blood pressure or other medications that can thin your blood, you may be more prone to bleeding after sexual intercourse. The thinner blood vessels combined with their swelling during arousal and the activity of penetrative sex can cause spotting. Anti-estrogen medication to treat endometriosis or uterine fibroids can also make the vagina more apt to bleed after sex.

Can Vaginal Dryness Cause Bleeding?

One of the more familiar causes of post-coital bleeding is vaginal dryness, which is much more common that you may realize. Vaginal dryness can be caused by:

• Stress
• Not being aroused enough before sex
• Breastfeeding
• Certain allergy or cold medications
• Certain antidepressants
• Perimenopause
• Cancer treatment drugs and other medications
• Over-douching
• Autoimmune conditions such as Sjögren’s Syndrome

If you’re experiencing vaginal dryness, you’re not alone. Try a vaginal moisturizer such as Replens™ Moisture Restore External Comfort Gel, use a personal lubricant during sex, and/or check with your doctor for advice.

Tips for Enjoying Sex if You’re Prone to Post-Coital Bleeding

If you’re someone who bleeds after sex and you’ve ruled out more serious underlying causes, the best thing you can do is expect that it may happen and be ready. Try these tips to deal with benign post-coital bleeding:

1. Talk with your partner. Seeing blood after sex may be concerning for them, too, so knowing that it might happen and what to do will help. They don’t have to treat you like you’re fragile, but they can work with you to ensure that sex is pleasurable and pain-free.
2. Put down a towel before beginning. If you’re expecting some blood after sex, go ahead and put a towel down just in case. This can help provide some piece of mind and allow you to let go and enjoy sex.
3. Modify your sex position. Certain positions allow for deeper penetration and may up your chances of bleeding.
4. Extend foreplay before penetration. Not only is this fun, but it also helps your body increase its natural lubrication for reduced friction during sex that can lead to post-coital bleeding.
5. Use a personal lubricant. Lube can make sex more enjoyable and help reduce your chances of bleeding after intercourse.
6. Use a vaginal moisturizer or estrogen replacement cream. Ask your doctor if a vaginal estrogen cream is right for you or try an OTC vaginal moisturizer that can improve your vaginal comfort every day, not just during sex.
7. See your doctor regularly. It’s important to monitor and maintain your vaginal health with regular visits to your gynecologist or primary care physician.

Bleeding after sex can be a mere annoyance or might be sign of something more serious. Pay attention to when you bleed, how much, and how often, and rule out any medical conditions that might be the cause.