7 Reasons You're Bleeding After Sex

Having sex naturally involves bodily fluids, but blood isn't a fluid you want to see on your sheets. Vaginal bleeding or spotting after sex—medically known as postcoital bleeding—can be concerning, but it's usually not a medical emergency. Here are some reasons you might experience vaginal bleeding after sex.

Frequency of Post Sex Bleeding

"A small amount of spotting is probably normal and fine if it happens one time or on a rare occasion," Nichole Mahnert, MD, an OB-GYN at Banner University Medical Center Phoenix, told Health. But if post-sex bleeding happens more than once, it's time to check in with your healthcare provider. 

Some health concerns like an infection or cervical cancer can also cause bleeding after sex. "Most causes are not dangerous, but a few are," Felice Gersh, MD, an OB-GYN and the founder and director of the Integrative Medical Practice of Irvine, told Health.

If you have a vagina bleeding after sex it isn't related to period blood. Anyone can deal with bleeding after sex including people who are still menstruating, no longer have a period, or have entered menopause. You may notice red spots on the bed, on your underwear, or between your legs after sex. 

Vaginal Dryness

If your vagina is not well lubricated, friction during penetrative sex can tear sensitive vaginal tissues and lead to bleeding, said Dr. Gersh. This can also make sex uncomfortable or painful. Vaginal dryness is typically caused by:

• Hormonal changes: Dropping estrogen levels after giving birth, while breastfeeding, during perimenopause, and after menopause can lead to vaginal dryness.
• Having sex before you’re aroused: The friction can lead to micro-tears in your vaginal tissue.
• Chemotherapy: Chemotherapy can damage your ovaries so that they no longer produce estrogen and progesterone, which can also lead to vaginal dryness.

You can help restore moisture to your vagina and avoid sex-related pain or bleeding. Your healthcare provider can talk to you about options that include lubricants, moisturizers, and vaginal estrogen, depending on the cause of the dryness.

Birth Control

Any type of hormonal contraceptive can lead to spotting after intercourse, said Dr. Mahnert. Spotting between periods, or breakthrough bleeding typically happens when you start a new hormonal birth control. It's even more common if you're on low-dose or ultra-low-dose birth control pills, have an intrauterine hormonal device (IUD), or have an implant.

After a few months, your body will usually adjust, and breakthrough bleeding will stop. However, bleeding doesn't always go away, especially if you have the implant. Some people using hormonal birth control may also experience vaginal dryness. This may cause tearing and some bleeding after sex.

Talk to your healthcare provider if you think your birth control is the cause of your post-sex bleeding. They may recommend alternative birth control methods.

Sexually Transmitted Infections

Sexually transmitted infections (STIs) can cause post-sex bleeding—especially if the infection leads to an inflammation of the cervix, called cervicitis. "A very irritated cervix can bleed with rubbing," said Dr. Gersh. 

STIs like chlamydia, gonorrhea, trichomoniasis, and herpes can cause cervicitis. So if you have one of these STIs, sex can irritate your cervix—the area between your vaginal canal and uterus—and cause bleeding. 

Gonorrhea and chlamydia can also lead to pelvic inflammatory disease (PID), an infection of the reproductive organs. This infection can cause bleeding between periods, bleeding after sex, pelvic pain, and unusual discharge and odor. Untreated PID can also lead to scar tissue and infertility. 

"Most [people] do not have symptoms of STIs, which is why it's important to seek treatment when you do have a symptom like abnormal bleeding," said Dr. Manhert.

Uterine and Cervical Polyps

Polyps are teardrops of tissue that form in the reproductive tract on the cervix or inside the uterus. "They have many blood vessels feeding them and can bleed if bumped around, so you'd see small amounts of blood after intercourse,” said Dr. Gersh.

Cervical polyps can hang down from the cervix into the vagina, where they might get touched or hit during sex. Since your uterus is connected to the cervix, polyps inside your uterus may also become irritated during sex.

Anyone can have polyps, but they're more common in people who are older than 40 or have entered perimenopause—the transitional period before menopause. Both uterine (aka endometrial) and cervical polyps are usually benign, meaning they are non-cancerous growths. But in rare cases, these polyps can turn into endometrial and cervical cancer. 

Chat with your healthcare provider if you think a polyp is to blame for any blood you see after sex. Treatment isn't always necessary, but depending on their size and your symptoms, you may need surgery.

Bacterial Vaginosis or Yeast Infection

"Any kind of infection can cause inflammation and irritation, which can result in bleeding," said Dr. Mahnert. Bacterial vaginosis (BV), which is caused by an overgrowth of bacteria, is the most common vaginal infection in people between 15 and 44 years old. Most people with vaginas will also experience at least one yeast infection in their lifetime.

Symptoms of BV can include:

• White or gray discharge
• Itching
• Burning
• A fishy vaginal odor
• Swelling

That said, bleeding isn't the most common symptom with bacterial vaginosis or a yeast infection. Most people with BV don't have any symptoms. "But if the cervix is infected and becomes inflamed, aka cervicitis, there could be some small amounts of blood seen after sex, due to the rubbing," said Dr. Gersh.

Uterine Fibroids

Fibroids are a non-cancerous growth made from the uterus' muscular tissue. A fibroid typically grows out of the uterine wall and can be as small as a pea or larger than a grapefruit. "Fibroids can cause bleeding when they are all or partially within the uterine cavity," said Dr. Gersh. "They have a lot of blood in them, and with the bouncing movements of sex, they can begin to bleed."

If you have a vagina, fibroids are the most common growth found in the pelvis. In fact, more than 75% of women will have fibroids at some point in their reproductive years. You're more at risk of developing fibroids if you're between 30 and 40 years old. Black people with vaginas are also more likely to deal with fibroids than white people.

Most people don't know they have a fibroid. And even if you are diagnosed with one, treatment usually isn't necessary unless the fibroid grows too large. If that does happen, your healthcare provider may consider treatment options, including medication or surgery to remove the fibroid.

Cervical Cancer

Cervical cancer is cancer of the cervix – the area between your vaginal canal and the bottom of your uterus. Bleeding with sex is the main symptom of cervical cancer. "The bleeding is typically light and painless,” said Dr. Gersh. It's due to the vascular nature of cervical cancer and that the friction of sex can irritate tissue and cause bleeding.” The good news is cervical cancer is highly treatable if found early, thanks to screening tests like the Pap smear. 

The HPV (human papillomavirus) test also looks for high-risk types of HPV that can lead to cervical cancer. Thousands of new cases are diagnosed in the U.S. each year, and folks can still die from cervical cancer if not found and treated. You're more at risk of developing cervical cancer if you're 30 years old or older.

Still, if you have abnormal bleeding regularly, tell your healthcare provider ASAP. They'll want to examine your cervix closeup and ensure you're up to date with your Paps and HPV testing.

A Quick Review

Bleeding after sex on occasion usually isn't a big deal. Friction from sex, especially if your vagina is dry, can cause tearing and bleeding. But if you consistently notice vaginal bleeding after sex, or have any pain during sex, talk to your healthcare provider. If vaginal dryness is to blame, they may recommend using a vaginal moisturizer, hormonal treatments, or a personal lubricant to help reduce friction and make sex more comfortable. 

It is possible that post-sex bleeding is related to a more serious infection, STI, or cancer. Any time you notice abnormal discharge, odors, bleeding, or pain, you could have a health condition that needs treatment. Visiting your healthcare provider can help you rule out what's causing any bleeding after sex.