The question is not whether to get worried if you bleed during sex. The correct question is when to panic? Bleeding during sex can be a real buzzkill? Why would this be happening?
In what universe is this normal? Anyway, even though you should be worried, some of these cases are normal. It is not uncommon to bleed especially if you are menstruating or are post-menopausal. The bleeding can be distressing but the reasons you are bleeding during sex can be benign most of the time.
According to research, vaginal bleeding that is not related to menstruation is a common complaint from women. Postcoital bleeding consists of bleeding or spotting unrelated to menstruation that can occur either during or after sex. The research found that as many as nine percent of women who menstruate, experience vaginal bleeding after sex. Another research found around 46-63% of postmenopausal women experience itching, tenderness, dryness and bleeding (or spotting) during or after sex. This is caused by hormonal changes affecting the vaginal tissues elasticity.
Some of these causes of vaginal bleeding may not be of concern but sometimes bleeding during or after sex can be a sign of a serious problem.
Causes of bleeding during sex but no pain
There are various reasons why you may experience a bloody discharge during intercourse and not feel any pain. The following are some of the most common causes that your doctor may discuss with you.
Direct trauma to the uterus, cervix and vagina can also lead to bleeding during sex. Most causes of trauma to these tissues are rough sex or tears and scrapes to the vagina. This can occur especially if vaginal dryness is present or the vagina is not lubricated enough during sex.
Although the vagina is self-lubricating, sometimes we don’t give it enough time to make its natural lube (this makes it slippery which protects the vaginal membranes.) Friction with a dry vagina can result in tears that can lead to bleeding.
Tears to the vagina caused by tampon use or when masturbating can also lead to bleeding during sex due to friction.
Other distressing causes of trauma include sexual violence or abuse. Forced entry traumatizes and damages vaginal tissues which lead to fissures that keep recurring if not treated.
Cervical cancer is the cause of postcoital bleeding in almost 11% of women who have cervical cancer. The bleeding is a symptom of vagina, cervical and uterine cancer.
Tumors vary depending on the type of cancer one has. The tumors are fed by a dense network of blood vessels. The vessels become strained as the tumor grows and are prone to bursting. The bursting can happen during sex causing vaginal bleeding.
If cancer is suspected as the cause of vaginal bleeding during sex, a pap smear will be done first to evaluate whether cervical cancer is present. A tissue sample is then examined by the doctor.
Cervical Dysplasia is when an abnormal growth of cells occurs on the cervix surface. It’s a pre-cancerous condition caused by STIs with the HPV (Human Papillomavirus) being the most common cause.
One of the symptoms is bleeding during intercourse, a problem that can be identified through pap smears. Treatment should be done immediately before these precancerous cells develop into cancer.
Sexually Transmitted Infections
These include chlamydia and gonorrhea. They are associated with symptoms that include itching, pelvic pain virginal discharge, burning and painful urination. These STIs cause surface blood vessels to swell due to inflammation. During intercourse, the vessels may burst depending on how severe the infection is.
Another STI that can cause bleeding during sex is trichomoniasis. This is caused by a single-celled parasite. Its symptoms include cervical bleeding and cervical discharge.
Other STIs like genital herpes and syphilis cause open ulcerative lesions prone to bleeding when irritated. The sores appear externally most of the time but can also happen inside the vagina. They are entirely unnoticeable and painless.
These STIs can be treated with an antibiotic.
Cervical polyps or uterine endometrial polyps are benign growths that happen in the cervix and uterus respectively. They are a common cause of vaginal bleeding during or after sex.
Women in their 40s and 50s with multiple pregnancies tend to develop cervical polyps. The polyps appear red or violet and have a tube-like structure that is rich with capillaries that bleed when touched.
Uterine polyps on the other hand mostly bleed after menopause, between menstruation, and during sex. They appear as small, soft lumps of tissue that protrude within the uterus. Women between age 36 to 55 are prone to uterine polyps.
Majority of these polyps are benign but can become cancerous with time. Polyps sometimes disappear after some time but in severe cases, surgery is required to remove them.
Vaginal Atrophy (Atrophic Vaginitis)
Vaginal atrophy is caused by a reduction in estrogen levels. Estrogen keeps vaginal tissues healthy and lubricated. If the levels get low, the vaginal tissues become thin, shrunken and dry. This makes it prone to inflammations that could lead to vaginal bleeding during sex.
Conditions that lead to low estrogen levels include menopause, breastfeeding, premature menopause, surgical removal of ovaries, cancer chemotherapy, hormonal treatment for breast cancer and medications that reduce estrogen levels, for example, when treating endometriosis or fibroids.
Treatment can be through estrogen therapy which includes an estrogen pill, suppositories that a woman can insert into the vagina, a vaginal estrogen ring or estrogen skin patch. One can also use a water-soluble lubricant that can be purchased over the counter.
Though non-cancerous, cervical ectropion is a condition where cells that line the cervix on the inside, protrude out through the cervix opening (cervical os). If this happens, fragile blood vessels dilate and get inflamed. This then causes bleeding during intercourse or when inserting a tampon or speculum (during pelvic exams).
It occurs in adolescents, pregnant women and women on birth control pills since their cervixes are softer than normal. Treatment is not required unless excessive vaginal bleeding or discharge occurs.
Endometriosis can cause bleeding after sex or during sex. The uterus is lined with endometrium, a tissue that thickens when hormones are released every month in preparation for an egg.
The egg gets fertilized when you get pregnant and the fertilized egg will attach to the endometrium and start growing. If pregnancy does not happen, the endometrium breaks down and sheds in the form of blood (your menstrual period).
If you have endometriosis, the tissue that lines the uterus grows outside the uterus and sheds itself every month just like the one inside your uterus. Since these implants are outside the body, the blood cannot use the uterus to flow out of the body. These implants get irritated and painful and sometimes form scars or cysts that make it hard to get pregnant.
Treatment of endometriosis depends on how severe it is and whether the woman would like to get children or not. If not severe, anti-inflammatory pain relievers like ibuprofen can be used to relieve pain.
Birth control pills can also be used to control endometrial tissue growth and reduce inflammation. If they become severe, surgery may be done to remove endometrial tissue patches. This will relieve the pain temporarily since the endometriosis can return.
If they return, then hysterectomy can be an option. This involves removal of the uterus.
If you notice any type of bleeding either during or after sex, contact a doctor, even though the bleeding is due to trauma. Early diagnosis of problems like cancer ensures early treatment and the cure of the malignancy before it gets serious.
- Obstetrics and Gynecology International: Postcoital Bleeding: A Review on Etiology, Diagnosis, and Management
- Journal of Menopausal Medicine: The Recent Review of the Genitourinary Syndrome of Menopause
- Hopkins Medicine: What is Cervical Dysplasia?
- Cleaveland Clinic: Uterine Polyps
- Healthline: What Is Cervical Ectropion (Cervical Erosion)?
- Harvard Health Publishing: Vaginal Atrophy (Atrophic Vaginitis)
- Sex Info: Endometriosis