Postcoital Bleeding (Bleeding After Sex)

Postcoital bleeding, which can affect women of all ages, occurs in approximately 9% of reproductive-age women. It often manifests as spotting or minor bleeding, which may not be a cause for significant concern. However, if postcoital bleeding becomes recurrent or involves a substantial quantity of blood, seeking medical consultation for appropriate management is recommended.

Causes and Sites of Postcoital Bleeding:

Vaginal Dryness: During intercourse, insufficient lubrication, often due to inadequate foreplay, can lead to tissue friction and subsequent bleeding. Other factors contributing to vaginal dryness may include:

Hormone imbalances, such as estrogen deficiency, are found in conditions like genitourinary syndrome of menopause (GSM).

Allergic reactions to certain products applied to the genital area.
Medications like cold or asthma drugs, antidepressants, or anti-estrogen medicines.
Cancer treatments like chemotherapy and radiation therapy.
Medical conditions like Sjögren's syndrome and vaginal atrophy.

Infections/Inflammation: Inflammation can result in fragile blood vessels, making them more susceptible to bleeding.
Vaginal Tearing: Rough sexual activities can cause small vaginal tears.
Cervical Ectropion (Eversion): This condition, where cervical cells extend outside the cervix, is more common in women using hormonal contraceptives, pregnant women, or teenagers.
Cervical Polyps: Non-cancerous growths that develop due to hormonal fluctuations or chronic inflammation, often containing blood vessels, making them prone to bleeding.
Uterine Prolapse: When the uterus, including the cervix, prolapses into the vagina, it can cause bleeding during or after intercourse.
Cancer: Pre-invasive and invasive cancers can exhibit bleeding upon contact or irritation, especially during sexual activity.

When to see a doctor?

If you experience:

Frequent or excessive vaginal bleeding.
Vaginal itching or burning during urination.
Abnormal or persistent vaginal discharge.
Itching or pain during urination.
Vaginal bleeding after menopause.

Diagnosis

Doctors typically diagnose postcoital bleeding through a comprehensive assessment, including medical history, physical examination (including a pelvic exam), and possibly additional laboratory investigations, such as vaginal discharge tests, Pap smears, biopsies of suspicious lesions, or other relevant tests like transvaginal ultrasounds, urine tests, or blood tests.

Treatment and Prevention

Treatment and prevention strategies depend on the underlying cause of postcoital bleeding and may include:

Abstaining from sex for a few days after menstruation
Using lubrication and avoiding rough sex when experiencing vaginal dryness
Antibiotics if an infection is present.
Surgical removal for cervical polyps or suspicious cancerous lesions
Early treatment for cancer-related bleeding to increase the chances of a cure
Weight reduction, Kegel exercises to strengthen pelvic muscles for minor uterine prolapse, or surgical repair for severe symptoms.

In summary, all reproductive women should maintain a menstrual calendar. Additionally, women should undergo an annual pelvic examination and cervical cancer screening after age 25 or earlier if they have any risk factors.