Bleeding after intercourse – the most common causes, diagnosis and further treatment

We associate bleeding after intercourse primarily with the rupture of the hymen. Loss of virginity may cause one-time, mild bleeding or minor spotting. In this case, we are dealing with a physiological cause of bleeding. Repeated bleeding after intercourse indicates various diseases of the reproductive organs. Bleeding after intercourse, which occurs in perimenopausal and postmenopausal women, may be associated with, for example, cervical cancer.

What is bleeding after intercourse?

Bleeding after intercourse is a symptom of many gynecological diseases and other pathological changes in the female reproductive tract. Bleeding after intercourse may occur as a result of hormonal disorders and be related to, among others: causing vaginal dryness, reduced production of vaginal mucus and estrogen deficiency. Lack of vaginal hydration leads to damage to the superficial layers of the genital tract, which may result in minor bleeding or spotting after intercourse. Bleeding after intercourse may also be caused by lack of foreplay and too deep penetration. Some women experience bleeding after having an IUD inserted.

If light bleeding after intercourse occurs during ovulation, we may be dealing with ovulation bleeding, which has a physiological basis. Another type of physiological bleeding that may occur after intercourse is implantation bleeding – implantation bleeding occurs in a small percentage of women 6-12 days after conception.

It happens that bleeding after intercourse is related to health or life-threatening diseases. Bleeding after intercourse may indicate, among others: inflammation of the pelvic organs and infections that may result from untreated or incorrectly treated intimate infections and sexually transmitted diseases.

Endometrial cancer, cervical cancer and vaginal cancer, as well as other female cancers, can cause bleeding after intercourse and bleeding and spotting between periods. The symptom of even minor vaginal bleeding, which is contact bleeding or occurs spontaneously, cannot be underestimated. Any bleeding that is not related to menstruation should be consulted with a gynecologist.

Bleeding after intercourse due to disease is usually not the only symptom of disorders in the functioning of the body. Most often, they are accompanied by lower abdominal pain, abnormal vaginal discharge, and changes in the genitals.

Bleeding after intercourse as a symptom of hormonal disorders

Hormonal disorders are one of the causes of bleeding after intercourse and bleeding and spotting between periods.

Vaginal dryness may be related to estrogen deficiency during menopause. Atrophy of the vaginal and vulvar mucosa often occurs in postmenopausal women. This disease significantly affects the quality of sexual life, leading to, among others: decreased elasticity of the vaginal walls and stress urinary incontinence.

The lack of vaginal mucus, the feeling of vaginal dryness and the associated vaginal burning are also side effects of using hormonal contraception. Physiological vaginal dryness, which is related to fluctuations in hormone levels, often occurs in women after childbirth and during lactation.

Important! Vaginal dryness should not cause heavy bleeding. Bleeding after intercourse, manual gynecological examination or vaginal ultrasound may indicate blood clotting disorders.

Bleeding after intercourse as a symptom of inflammation of the reproductive system

Inflammation of the reproductive system is a common cause of bleeding after intercourse. This symptom may indicate, among others:

• adnexitis,

• inflammation of the cervix,

• inflammation of the uterine lining.

Inflammation in the pelvic area also causes other symptoms, e.g.:

• pain in the lower abdomen,

• lower back pain

• pain during intercourse,

• vaginal discharge,

• pain and problems when urinating.

Inflammation of the reproductive system organs may be caused by, among others: untreated bacterial and fungal diseases of the vagina and vulva. Intimate infections require vaginal cleansing and appropriate treatment. The use of over-the-counter drugs, although they often bring quick relief, may cause the infection to become asymptomatic and latent, leading to, for example, inflammation of the appendages. Symptoms of an intimate infection should always prompt a visit to a gynecologist who, based on the test results, will determine their cause and select appropriate treatment. Importantly, in the case of an intimate infection, treatment should not be discontinued after the symptoms disappear – the treatment should be completed, which reduces the risk of recurrence of the infection.

Venereal diseases as a cause of bleeding after intercourse

Casual unprotected sex is one of the most common causes of the development of venereal diseases, which may include bleeding after intercourse. Venereal diseases that may cause this symptom include:

• gonorrhea,

• syphilis,

• genital warts,

• herpes of the labia,

• Hodgkin’s disease venerealis.

Human papillomavirus infection, which often occurs during sexual contact, may result in vaginal endothelial neoplasia, which increases the risk of developing vaginal cancer.

Bleeding after intercourse and pathological changes in the uterus and ovaries

Various pathological changes may occur within the female reproductive system. Bleeding after intercourse may be caused by, for example:

• adhesions,

• ovarian cysts,

• cervical polyps,

• uterine fibroids.

Sometimes the cause of bleeding after intercourse is endometriosis.

In the case of pathological changes in the uterus and ovaries, other symptoms also occur, e.g. lower abdominal pain and lower back pain.

Cancer and bleeding after intercourse

Bleeding after intercourse often indicates cancer developing in the vagina, cervix or uterine body. Women’s cancers do not only affect perimenopausal and postmenopausal women. Bleeding after intercourse is a symptom of primary cervical cancer, endometrial cancer, vaginal cancer and vulvar cancer. Other symptoms that appear in the course of reproductive organ cancer include:

• menstrual disorders in women of reproductive age and postmenopausal bleeding,

• abnormal vaginal discharge, e.g. blood-tinged discharge,

• enlarged abdominal circumference,

• stomach pain,

• pain during intercourse,

• changes in the vulva area, e.g. erosions, lumps, non-healing wounds.

It is worth remembering that the prevention of diseases of the reproductive organs includes regular visits to a gynecologist, which should not take place less than once a year. For women at increased risk of developing gynecological cancers, more frequent preventive visits are recommended.

Cervical cancer is the most frequently diagnosed gynecological cancer. The risk of cervical cancer increases, among others: in women infected with human papillomavirus (HPV) – the HPV virus is the cause of approximately 99% of cervical cancer cases. Other risk factors for developing cervical cancer include: smoking, long-term use of contraceptive pills and chronic inflammation in the reproductive organs.

Women’s cancers that are detected at an early stage have a better prognosis. In many cases, early detection of cancer allows for complete recovery. Important in prevention and diagnosis, among others: Cervical cancer is a cytological test.

Genital bleeding may be associated with sexual violence

Contact bleeding is also caused by sexual violence. Rape in a civil partnership or marriage is no different from an act prohibited by the Penal Code – in accordance with Article 197 § 1 of the Penal Code: whoever, by force, unlawful threat or fraud, causes another person to have sexual intercourse, shall be subject to the penalty of imprisonment for a term of between 2 and 12 years. .

A woman subjected to sexual violence may experience not only bleeding, which indicates vaginal damage, but also a tear in the perineum. A woman who has experienced sexual violence should be examined by a doctor.

Sexual violence against women and men is still a taboo topic. It applies not only to being forced to have sexual intercourse, but also to practicing unacceptable forms of intercourse and being forced to perform other sexual activities.

Sources:
Dębski R., Clinical gynecology, Volume I-III, Elsevier Urban&Partner Publishing House, Wrocław, 2009
Bręborowicz G., Obstetrics and gynecology, Volume 2, Wydawnictwo Lekarskie PZWL, 2020