Question:

I’ve been having sex with my boyfriend for more than a year. In the last couple of months, I’ve had bleeding during sex. It’s happened a bunch of times, it’s very embarrassing and I don’t know what’s causing it. Neither of us have had sex with other people since we got together, so it can’t be an STI, can it?

Answer:

Sorry to hear about your experiences with bleeding during sex. It can feel scary and, yes, sometimes embarrassing for some women to notice, especially when they have no idea why it’s happening to them. That said, vaginal bleeding is nothing you need to feel bad or embarrassed about, as bodies are quirky sometimes – and, for all their oddities – they are often very good at letting us know when something may be wrong and needs to be checked out by a healthcare provider. In my opinion, vaginal bleeding is always worth mentioning to one’s healthcare provider even though it’s not always a sign of a serious medical condition.

Although many women will notice small amounts of blood after sexual intercourse (this is often more easily noticed when one pees after sex or, the next day, in noticing small amounts of blood on one’s underwear), it is less common to notice more moderate or larger amounts of blood loss during sex itself. Here are some common causes of bleeding during or after intercourse… as well as, in some cases, what you can do about it.

Small amounts of bleeding noticed after intercourse may be caused by small vaginal tears (sometimes called “micro-tears”) in the vaginal wall or even on the vulva (the outside parts of a woman’s genitals). These often heal within 1-3 days after sex and may more easily heal if you try not to further aggravate these tears with more sex, masturbation, tampon use or other types of vaginal penetration (such as fingering). When a woman returns to sex, she and her partner might consider using a water-based or silicone-based lubricant to reduce friction and thus reduce the risk of more tearing which would – you guessed it – possibly result in more bleeding after sex.

Bleeding during or after sex can also be a sign of a sexually transmissible infection (STI) that may have caused irritation to or inflammation of a woman’s reproductive organs, such as her cervix and uterus. Often, however, STI-related bleeding also shows up as vaginal bleeding or discharge even on days when a woman is not having any sex at all. If a woman thinks there is any possible chance at all that she may have an STI, she should check in with her healthcare provider for STI testing and possible treatment. Some infections, such as chlamydia, can result in what’s called a “friable cervix” which is a cervix that is prone to bleeding (there are other causes of a friable cervix, too, and vaginal bleeding should always be checked out by a healthcare provider).

Benign growths in the uterus (such as polyps and fibroids) may also be linked to bleeding during or after intercourse and, again, this is a reason why vaginal bleeding should be brought to a healthcare provider’s attention as polyps and fibroids aren’t something you can diagnose yourself.

In rare cases, a bleeding disorder or other medical condition may be at the root of vaginal bleeding so don’t be afraid to return to your healthcare provider or seek a second opinion if you continue to bleed during or after sex even if or after you receive a diagnosis or treatment.

In some cases, a woman may notice blood coming from her vagina after sexual intercourse and think it’s her own blood, only to find that her partner had blood in his semen that he then ejaculated into her vagina, and as it came out (thanks to gravity!) it seemed like it was vaginal bleeding when in reality it was a reflection of the man’s health issues (not hers – and, yes, men should speak with their healthcare provider if they notice blood in their semen). So when a woman notices blood after intercourse, she might also ask her partner (if her partner is a man) whether he’s noticed any blood in his semen during recent acts of masturbation. If he hasn’t masturbated in a while, she might encourage him to (or they can engage in hand-penis couple play, aka a hand job) here and there to see if he has blood in his semen.

Bottom line: there are many possible causes of vaginal bleeding during or after sexual intercourse and women should always bring vaginal bleeding to the attention of their healthcare provider/gynecologist.