Bleeding After Sex: Common Causes and When to Get Help

Sex should be a positive experience. But there are times when you may have symptoms associated with sex that can be alarming. One of those symptoms is bleeding after sex (postcoital bleeding). 

Most causes of postcoital bleeding are easy to treat. But sometimes it can be a sign of something more serious. Let’s take a closer look at what causes bleeding after sex and how to treat it.

What is postcoital bleeding and is it normal?

Postcoital bleeding is any bleeding or spotting that happens after sex when you’re not on your period. And it’s pretty common. Experts estimate that almost 1 in 10 people who have monthly periods experience bleeding after sex. While it’s usually associated with vaginal sex, it can also occur after anal sex. 

The causes of postcoital bleeding vary. So a visit to a healthcare professional can help you figure out the source of the bleeding. Other clues to what may be causing your bleeding after sex can be symptoms like:

• Pain or discomfort

• Itching

• Discharge

• Odor

So, if you experience bleeding after sex, try to make a note about the other symptoms you notice and when they occur. This can help your healthcare professional make the right diagnosis.

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• Vaginal bleeding and menopause: Find out the reasons you may have vaginal bleeding after menopause.

What amount of bleeding is normal after sex?

Heavy bleeding after sex is rare, and it’s never normal. Heavy bleeding can be a sign of a vaginal injury, a mass in the cervix, or another abnormality like cancer or a polyp. 

If you’re not sure whether your bleeding is heavy, a useful metric is how often you need to change your pad or tampon. If you need to change two or more pads or tampons within 1 hour, it almost always means you have heavy bleeding. Get medical care right away if you have heavy bleeding after sex. 

Spotting or light bleeding after sex is much more common and can be normal. Light bleeding after sex can be caused by various forms of birth control or by normal changes to the vagina that occur after menopause, during pregnancy, or in adolescence. Not all causes of light bleeding after sex are normal though. Sexually transmitted infections (STIs) or different forms of gynecological cancers can also cause light bleeding after sex. 

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Because so many different things can cause bleeding after sex, it’s impossible to tell whether the bleeding you experience is normal based on the amount of bleeding alone.

Is it normal to have bright red bleeding after sex?

The color of blood after sex can help determine the cause of the bleeding. Dark blood or spotting after sex usually is caused by menstrual blood from the uterus. Bright blood after sex is usually caused by bleeding from a vaginal injury or by bleeding from other areas like the cervix or vagina. See a healthcare professional if you have bleeding after sex. They can help you figure out the source of the bleeding.

What causes bleeding after sex?

There are many causes of vaginal bleeding after sex. The source of the bleeding can be any part of the reproductive tract. This includes the vagina, cervix, and uterus. Let’s review some of the most common causes.

Infection

Infections, particularly of the cervix, can lead to bleeding after sex. When an infection occurs, inflammation makes the cervix more fragile. This makes it more likely to bleed after sex. You may also notice increased vaginal discharge, itching, or odor as well. This is often the case with STIs and other conditions that cause irritation, including: 

• Chlamydia 

• Gonorrhea

• Trichomonas  

• Cervicitis

• Genital sores

• Pelvic inflammatory disease (PID)

• Bacterial vaginosis

• Yeast infection

Damage or trauma

During sex, trauma to the vagina or cervix can cause damage, like tears or abrasions. And these injuries can lead to bleeding and pain. Vaginal tears are more likely to happen in people who have had thinning of the lining of the vagina. This commonly happens in menopause. Damage can also occur during rough sex or when using sex toys and other foreign objects. 

Polyps

Polyps are benign (noncancerous) growths that can come from the inside of the uterus or cervix. During sex, polyps can start to bleed. Experts aren’t sure why these polyps develop. They usually aren’t painful, and bleeding after sex may be the only sign that they’re present. Sometimes, you may notice a white or yellow vaginal discharge.

Cervical polyps are common in people older than 40 years. This is especially true if you have delivered several babies. Uterine polyps tend to be more common in those younger than 40. 

Cervical ectropion

Cervical ectropion is when the cells from the inner portion of the cervix are on the surface of the cervix. These cells are more delicate than the cells that are usually on the surface of the cervix. So bleeding is more likely to happen when cervical ectropion is present. Cervical ectropion can commonly cause a white or yellow vaginal discharge.

Cervical ectropion is normal and nothing to worry about. It occurs most often in:

• Younger people

• Pregnancy

• People who take hormonal birth control (most often with oral contraceptives)

Birth control

Any form of birth control that uses estrogen can cause bleeding after sex. These include oral estrogen-progestin pills, the vaginal ring, or the transdermal patch. This happens because  estrogen causes subtle changes to the cells of the cervix, making them more likely to bleed. Bleeding due to birth control is not dangerous, but if it becomes an issue, you can talk with a healthcare professional about switching to a different form of birth control.

Cancer

Bleeding after sex can be a sign of cancer of the vagina or the cervix. It’s unclear exactly how often cancer is the source of postcoital bleeding. But this risk appears to increase with age. 

Beyond bleeding, symptoms of vaginal cancer are:

• Abnormal vaginal discharge

• A lump in the vagina

• Pain with sex

• Pain when you urinate

• Constipation

• Pain in lower belly

Symptoms of cervical cancer are:

• Bleeding between periods

• Heavy or prolonged periods 

• Vaginal discharge

• Pain with sex

• Pelvic pain

Treatment for these cancers is most effective when the cancer is found early. So connect with a healthcare professional if you experience bleeding after sex. 

Vaginal dryness

Having sex if you have vaginal dryness can make tears and irritation to the vaginal lining more likely. This type of superficial vaginal injury can lead to bleeding after sex. And it’s likely to be slightly painful or uncomfortable. 

Vaginal dryness can happen as a result of:

• Menopause or other hormonal changes

• Dehydration

• Autoimmune conditions like Sjögren’s disease

Endometriosis

Endometriosis is when cells that are supposed to be inside the uterus are found elsewhere in the body. This means that cells that normally line the uterus can sometimes be found in the vagina itself. 

These cells are more likely to become irritated with penetration, which can cause pain and bleeding with sex. Endometriosis is a complicated medical condition and you should speak with a gynecologist about treatment options for this. 

Uterine fibroids

Uterine fibroids are noncancerous growths that can occur in any part of the uterus. When these growths happen close to the cervix, you can have bleeding after sex. Uterine fibroids are also likely to cause heavy menstrual bleeding and pelvic pain.

Fibroids usually develop before menopause, and they’re quite common. Up to 8 in 10 women have fibroids by age 50. 

Bleeding disorders and blood thinning medications

People with bleeding disorders like hemophilia or Von Willebrand disease, or people on blood thinning medications are more likely to have bleeding after sex. Bleeding disorders and blood thinners don’t actually cause bleeding, but they do make it more likely that you’ll bleed after sex as a result of any of the other causes listed above. 

For example, if you have a bleeding disorder and get a small injury during sex, you might experience some bleeding after sex, whereas someone without a bleeding disorder might not.

Is it normal to bleed after anal sex?

Bleeding after anal sex is common. Unlike the vagina, the anus doesn’t create its own lubrication and its cells are less able to stretch without creating small tears. These small tears can cause bleeding. Sometimes this bleeding is noticed right after sex, and sometimes it’s not noticed until the next time you have a bowel movement. To help prevent bleeding after anal sex, it’s important to use lots of lubrication.

While small amounts of bleeding after anal sex is nothing to worry about, you should get medical care if you have large amounts of bleeding, pain with bleeding, or bleeding that lasts more than 1 to 2 days after sex.

What causes bleeding after anal sex?

Like vaginal sex, bleeding after anal sex can also be worrisome. You may see blood in the toilet or when you have a bowel movement or wipe. Let’s review some common reasons you may have bleeding after anal sex and when to seek medical care:

• Anal fissures are small tears to the lining of the anus. The trauma of penetration can cause these fissures, with pain and bleeding during bowel movements. 

• STIs like gonorrhea, syphilis, chlamydia, and herpes can occur in the rectum or anus. These infections can cause bleeding after sex. 

• Hemorrhoids can become irritated or damaged during anal sex, causing bleeding. 

Is bleeding after sex a sign of pregnancy?

Spotting is common in early pregnancy and may happen after sex as well. Bleeding after sex is also possible in pregnancy due to the hormonal changes that occur. And these changes can make the cervix more likely to bleed from sexual activity.  

If you’re pregnant and have bleeding after sex, let your healthcare professional know. They may do additional testing to make sure there are no issues with your placenta or pregnancy. 

How to stop bleeding after sex

The approach to stop bleeding after sex depends on the cause. You can work with a healthcare professional to figure out the best treatment for you. 

Common ways to stop bleeding after sex include:

• Antibiotics: You may need antibiotics if the bleeding is from an infection.

• Lubricants: Using more lubricant or being more gentle during sex can help prevent injury or trauma.

• More foreplay: This may help the body generate more of its natural lubricant.

• Cervical polyp removal: This is often a minor procedure that can be done in a healthcare office setting.

• Routine screenings: This can help to detect any cancer, infections, or vaginal and cervical changes.

• Estrogen therapy: Estrogen replacement can help if you have vaginal changes due to menopause or other conditions causing low estrogen.

When to get help for postcoital bleeding

For most people, bleeding after sex will stop on its own. But get treatment if the bleeding is heavy or happens regularly. In some cases, you should get emergency care as soon as possible. This includes:

• Bleeding so heavy that you have to change your pad or tampon every hour 

• Chest pain

• Shortness of breath

• Lightheadedness 

• Dizziness

And talk with your primary care provider if you’re pregnant, especially if you have cramping or pain.

Tests and exams to get if you regularly bleed after sex

A pelvic exam is the first step. During this exam, your healthcare professional will look for any obvious sources of bleeding. They may perform a Pap smear or other laboratory tests to look for infections or to check for pregnancy. 

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Written by:

Ijeoma Azonobi, MD, MPH

Ijeoma Azonobi, MD, is board-certified in preventive medicine and public health, and she also has a master’s in public health. Originally from Philadelphia, she moved to Atlanta, where she received her medical degree from Morehouse School of Medicine.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Farzon A. Nahvi, MD

Dr. Nahvi is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works clinically at Concord Hospital in Concord, New Hampshire, and is a clinical assistant professor of emergency medicine at the Geisel School of Medicine at Dartmouth. Prior to this, he worked as an ER physician and clinical assistant professor of emergency medicine at the Mount Sinai Health System, NYU Langone Health, NYC Health + Hospitals/Bellevue, and the Manhattan VA. He is a graduate of Cornell University and NYU School of Medicine.

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