Bleeding during or after intercourse, often termed post-coital bleeding, can occur because of many reasons. Cervical cancer is one of the most serious causes of post-coital bleeding. However, it is not the only cause. In fact, less than 6 percent women presenting with post-coital bleeding are likely to be diagnosed with invasive cancer. Some of the more common causes of bleeding associated with intercourse are precancerous changes in the cervix, cervical ectropion, infections and inflammation. Whatever the cause of bleeding associated with intercourse, it is not a symptom that you should ignore. It is advisable to contact your doctor at the earliest if you are experiencing bleeding during or after intercourse. Some of the common causes of bleeding during sex are discussed below.
Bleeding after intercourse could be a sign of cervical dysplasia, also called cervical intraepithelial neoplasia (CIN). Cervical dysplasia means the presence of abnormal cells in the cervix. Depending on the extent and type of the abnormality, cervical dysplasia may progress to cervical cancer. Low-grade cervical dysplasia usually resolves without any treatment. High-grade dysplasia has a significant chance of progressing to cervical cancer. Not all women with cervical dysplasia have bleeding or spotting after sex. It is a silent condition in a vast majority of cases, detected only through a pap-smear.
Post-coital bleeding is regarded a characteristic symptom of cervical cancer, though it may not be present until advanced stages of the disease. Widespread use of regular pap smears has reduced the incidence of cervical cancer in developed countries, but it remains among the leading cancers affecting women worldwide. Cervical cancer is most often seen in women more than 40 years of age. Other symptoms of cervical cancer may be bleeding between periods, post-menopausal bleeding, increased vaginal discharge, and pain during intercourse. Human papillomavirus (HPV) infection is an underlying factor in nearly all cases of cervical cancer.
Cervical ectropion is a condition in which the tissue lining the inner side of the cervix comes out onto the outer surface of the cervix. Since this tissue (columnar epithelium) is much thinner than the tissue that normally covers the outer surface of the cervix, underlying blood vessels show through it, making it red in appearance and also prone to bleeding.
Cervical ectropion is also called cervical ectopy or cervical erosion. It is not a premalignant condition and does not develop into cervical cancer. Use of oral contraceptive pills, childbirth and miscarriage are some of the reasons that could lead to cervical ectropion
Asymptomatic cervical ectropion does not require treatment. Cervical ectropion producing bothersome degree of vaginal discharge or post-coital bleeding can be treated with either freezing (cryotherapy) or cauterizing (diathermy). The procedures are painless and do not require hospitalization.
Cervical polyps are benign growths in the cervix. They are a rather common cause of bleeding after sex. Polyps may occur alone or in groups. Most polyps are 1 to 2 cms in length. It is usually not possible to feel the polyps on your own. Other associated symptoms are bleeding between periods, vaginal discharge that can at times have a foul smell, and heavy periods. The treatment is removal of the polyp.
Sexually transmitted diseases
Women having sexually transmitted diseases such as chlamydia and gonorrhea may have bleeding after intercourse. These are bacterial infections for which several effective medications are available. Another infection called trichomoniasis may also be associated with bleeding after intercourse.
Vaginal dryness in menopausal women
Estrogen is the chief hormone required to keep the vaginal tissue moist and elastic. As the levels of this hormone fall with menopause, the mucus membranes produce less lubrication, making the vagina very dry and thin. This condition is also called atrophic vaginitis. It can occur because of other causes as well, but is mostly associated with menopause. Thin and dry vagina is more prone to injury during intercourse which can lead to pain and at times, bleeding. Your doctor can prescribe adequate over-the-counter lubricants to relieve your condition. Some women benefit from hormone replacement therapy.
Vaginal yeast infection
Vaginal yeast infection can also sometimes be associated with bleeding after intercourse. Other symptoms of yeast infection are itching and burning sensation along with an odorless, white, cheese-like discharge.
Uterine polyps are an overgrowth of the endometrial tissue. The chief symptom of uterine polyps is bleeding between periods. They may also cause bleeding or spotting after sex, spotting, heavy periods, bleeding after menopause, and breakthrough bleeding in women receiving hormone therapy.
Uterine fibroids are mostly benign tumors made of fibrous tissue. In some cases fibroid tumors do not produce any symptoms. In other women they can be associated with a variety of symptoms including bleeding after intercourse.
Endometritis or adenomyosis
Endometritis is an inflammation of the inner lining of the uterus. Adenomysis is a condition in which endometrial tissue attaches itself to the uterus, or grows outside the uterus attached to another organ such as the ovaries. Both the conditions can lead to bleeding after intercourse. A thorough gynecological examination is required for diagnosis.
Hymen rupture at first intercourse
The hymen is a small tissue that lies across the entrance to the vagina. Minor bleeding because of tearing of the hymen is common at first intercourse. The elasticity of the hymen varies from one woman to another. Not all women bleed at their first intercourse, so it is not medically correct to see bleeding as evidence of virginity. Many a times the hymen may have been broken by vigorous exercise, tampon use or by injuries such as the straddling of a bike. Moreover, the amount of bleeding from a torn hymen may be too minor to be noticed. Normal bleeding caused by first intercourse should stop within a day. If you are experiencing continued heavy or brisk bleeding after first intercourse it is advisable to consult a doctor, particularly if there is associated lower abdominal pain. Women who have stinging or burning associated with minor bleeding following first intercourse can use some pain killers. Avoiding further intercourse till bleeding stops and using extra lubrication during subsequent intercourse is also advisable.