A wide variety of behavioral and medical causes can lead to post-coital bleeding. Here are the most common reasons, as well as how to tell what’s normal and what isn’t.
Cleaning up after sex and finding blood on your body, the sheets, your partner, or the toilet paper can be quite alarming, but take a deep break and relax. Post-coital bleeding, or bleeding that occurs after sex, is fairly common and can result from many behavioral and medical causes, most of them not serious. Sometimes the cause is unknown, and it’s just one of those weird things that happens during sex. Most sexually active men and women will experience it at some point in their lives.
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Bleeding after sex is more common in women
Due to differences in anatomy and hormones, bleeding during or after sex is much more common in women than men, says Michael Ingber, MD, urologist, pelvic medicine surgeon, and assistant clinical professor of urology at Weill Cornell Medical College in New York. It occurs in about 0.7 percent to 9 percent of women, but the real numbers may be higher as many women don’t discuss it with their doctors. Causes include trauma to, illness, or infection of the uterine lining, cervix, vagina, or labia. Hormone changes are another common cause.
But it happens to men, too
The most common type of post-coital bleeding in men is hematospermia, or blood in the semen. About 0.5 percent of 26,500 men being screened for prostate disease reported hematospermia, according to a 2020 German study published in Deutsches Ärzteblatt International. The rates may be higher, however, as many men are hesitant to discuss it. Causes include trauma to the penis or testicles, illness, a physical obstruction, blood vessel problems, or infection.
Men may also experience scratching of the penis during sex that causes bleeding, although this is rare unless the sex is very rough.
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Don’t ignore post-coital bleeding
Fortunately, most cases of post-coital bleeding have benign causes, says Mary Jane Minkin, MD, OB/GYN and clinical professor at Yale University School of Medicine. But that doesn’t mean you should dismiss it. “Bleeding after sex is often just an annoyance, but it can be associated with some ‘bad things,’” she explains. “We need to pay attention to the potential problems and rule them out.”
And don’t ignore the combination of pain and bleeding after sex, either
Bleeding after sex accompanied by pain is a signal there may be an underlying problem to address. If painful bleeding happens just once and the pain isn’t severe, evaluate the sexual positions, toys, or sexual methods (like bondage) to see if one of those might be the culprit.
A specialist should evaluate severe or persistent pain that occurs during or after sexual activity—with or without bleeding, Dr. Ingber says. Pain during sex is fairly common, particularly for women, but this should never be considered normal, and it is reason enough on its own to seek medical help, he says.
Be on the lookout for other symptoms
If your post-coital bleeding is accompanied by fever, chronic discharge, redness, tenderness, swelling of the genital region, and/or pain, these symptoms may indicate an infection, serious disease, or organ injury. In this case, you need to see a doctor, according to Dr. Minkin.
When to call your doctor about bleeding after sex
“A small amount of bleeding can be common, and as long as it resolves and you are not in pain, there is usually no emergency,” Dr. Ingber says. Repetitive bleeding after sexual activity and/or bleeding with other symptoms is a cause to visit the doctor.
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Causes of bleeding after sex
Now that you know about the basics of bleeding after sex, here are the causes.
Hormones
Hormonal changes in women, particularly those that occur during perimenopause, puberty, menstruation, and pregnancy, can cause spotting or even light bleeding after sex, Dr. Ingber says. It’s most common in postmenopausal women, he adds.
These hormone changes can make your vagina more vulnerable to abrasions and tearing. They may also cause some bleeding independent of the sexual activity, although you may not notice it until after sex.
Menstruation
Period blood should not surprise women who menstruate or the men having sex with them, yet plenty of couples have been alarmed to discover menstrual blood after sex.
Sometimes the internal contractions that come with orgasm can stimulate the release of menstrual blood from an imminent period, causing your period to start a little bit earlier than you expected.
Improper use of sex toys
Sex toys, particularly if you don’t use them correctly, can cause post-coital bleeding, says Carol Queen, PhD, a sexologist and co-author of The Sex & Pleasure Book: Good Vibrations Guide to Great Sex for Everyone.
This is why it’s always important to read the directions and have lube on hand, even for solo encounters. If you start to feel pain, stop immediately.
“In our sexual health clinic, we see dozens of cases every year of women who have used sex toys improperly, or too aggressively, which have led to injury,” adds Dr. Ingber.
Anal sex
Anal sex can have some uncomfortable side effects, including bleeding after sex. It is not uncommon to have rectal bleeding or bloody stools after anal sex, Dr. Ingber says. This can be from small fissures (tears) in the anal mucosa, hemorrhoids within the anal canal or rectum, or trauma from a penis or sex toy.
Vaginal dryness
Post-coital bleeding is so common in postmenopausal women because the lack of estrogen causes the vaginal tissues to become thinner, and thus more sensitive to trauma or tearing, Dr. Minkin says.
Other causes of bleeding from vaginal dryness include breastfeeding, childbirth, some medications, female reproductive surgery, douching, chemical irritants in tampons or pads, or some illnesses like autoimmune conditions.
A top cause of bleeding from vaginal dryness is having penetrative sex before arousal, so be patient, use lots of lube, and don’t skip the foreplay, Queen says.
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IUDs or intrauterine devices
IUDs are a type of semi-permanent birth control inserted into the cervix. They come in hormonal and non-hormonal options, and both can cause spotting or bleeding outside of a woman’s normal menstruation, including after sex, Dr. Ingber says. Bleeding is more common right after insertion, but can occur any time. Sometimes, a man’s penis can bump the IUD during sex, which can be painful and may cause some spotting.
Vigorous intercourse
Rough sex can cause bleeding both during and after sex, Queen says. There’s nothing wrong with kink play if you enjoy it, but communication with your partner is key in staying safe and healthy. If you feel too much pain or start to bleed, consider changing how you have sex.
Pelvic organ prolapse
Pelvic organ prolapse is another common cause of post-coital bleeding.
This condition occurs after having children, when the pelvic organs—bladder, rectum, and uterus—can “fall” outside of their normal location, and protrude through the vaginal opening, Dr. Ingber says. “When the vaginal mucosa is outside where it is typically supposed to be, this can make the area more prone to bleeding and irritation,” he says.
STIs and other infections
In men, sexually transmitted infections are the most common cause of bleeding after sex, Dr. Minkin says. They can cause bleeding after sex in women, as well. Other infections, including pelvic inflammatory disease, vaginitis, and urinary tract infections are other common culprits.
(While the urethra isn’t usually involved in sex, sometimes blood from an injured or infected urethra can mix with other genital secretions and give the appearance of bleeding after sex.)
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Polyps
Benign growths called polyps can grow on the cervix, vagina, and lining of the uterus. They are sensitive to movement and pressure and can become irritated, leading to bleeding during or after sex, Dr. Ingber says.
Cancer
Even though your mind may have gone straight to cancer, we left this one for last because while it is serious, it’s a rare cause of post-coital bleeding.
Cancers of both the male and female reproductive systems can sometimes cause bleeding during or after sex. Cervical cancer is the one most doctors worry about, Dr. Minkin says.
“It is unlikely for one episode of spotting after intercourse to be secondary to something like cervical cancer,” Dr. Minkin says. “But if you have repeated episodes of such bleeding, you definitely want to contact your GYN health care provider, who will examine you and may do a pap smear or a biopsy of your cervix.”
Bottom line
Bleeding a little bit after sex every once in a while is normal and probably not cause for concern. But if it happens regularly, occurs with pain or other symptoms, or just doesn’t feel right, make an appointment to see your doctor.
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