Nothing kills the mood like discovering blood on the sheets after sex. While it may not be the sexiest part of sex, for many, it’s actually quite common.
“Bleeding during or after sex that is not related to the menstrual cycle occurs in about 6% to 10% of women,” says Rachel Bowman, MD, an assistant professor in the Department of Women’s Health at The Dell Medical School at the University of Texas in Austin.
Here are six reasons why you may be bleeding after sex, and when to seek medical attention.
Infections that can cause bleeding after sex include:
Chlamydia, genital herpes, gonorrhea, and trichomoniasis are all sexually transmitted infections. These infections can cause inflammation of the cervix, which is the canal between the vagina and the uterus. When the cervix is inflamed, penetration can cause irritation and possible bleeding. Most sexually transmitted infections can be easily treated.
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Meanwhile, yeast infections are not sexually transmitted but are due to fungal infections that affect the vaginal canal. Yeast infections cause irritation in the vaginal canal, meaning it is more likely to bleed during or after sex.
“With any type of penetration, if you aren’t lubricated enough, there is going to be a lot of friction,” says Jessica Geida, DO, an OB-GYN at Axia Women’s Health.
This friction can damage the vagina and lead to tears in the vaginal walls, causing bleeding.
Vaginal dryness can occur in women of all ages, but it is especially common in those with low estrogen levels, like post-menopausal and breastfeeding women. Estrogen contributes to the moisture and flexibility of vaginal tissue, making women in low-estrogen states more susceptible to bleeding during sex.
Other common causes of vaginal dryness include:
Polyps are small bulb-like growths on tissue linings. They are usually harmless and not painful, but they easily become irritated. So, if they are “bumped” during penetration, by a finger, toy, or penis, it can result in bleeding.
The two types of polyps that can cause bleeding are:
When you see your doctor about vaginal bleeding, they can quickly diagnose if a polyp is the root cause with a pelvic exam. Once diagnosed, these polyps can be removed by a healthcare provider in a simple, outpatient procedure.
Vigorous sex can be rough on the vagina and cause tears that may lead to bleeding.
Some bleeding after this type of sex usually isn’t anything to be concerned about. “Light spotting or pink discharge can be a very normal response as the vagina recuperates,” says Hector Chapa, MD, an OB-GYN at Texas A&M College of Medicine.
However, sometimes it can cause large tears or lacerations. If you are bleeding heavily — one soaking pad or tampon for an hour or more — go to the emergency room, as you may require stitches.
Abnormal vaginal bleeding is one of the earliest indicators of cervical cancer.
HPV — the leading cause of cervical cancer — can cause mutations in the cells in the lining of the cervix. These abnormal cervical cells can cause you to bleed after sex.
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“If someone presents with the complaint of postcoital, or post-sex, bleeding, one of the first things we do is check their pap smear history and make sure they are up to date with cervical cancer screening,” says Bowman.
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Any type of birth control that contains estrogen, like the patch or most pills, can cause a condition called cervical ectropion.
This is a non-threatening condition that causes cells inside the cervix to move into the vaginal canal. Because these cells are softer, penetration can cause them to bleed.
Cervical ectropion also commonly occurs in pregnant women, as estrogen levels naturally increase during pregnancy, and during adolescence when women experience hormonal changes.
Here are some tips on how to prevent or reduce bleeding after sex:
Lubricate. Lubrication is essential to protect the vagina from friction and bleeding that can happen during sex. Chapa recommends either extending foreplay or purchasing a lubricant. If you are experiencing vaginal dryness related to low estrogen levels, most health providers can prescribe a vaginal estrogen cream, says Bowman.
Get routine pap smears and the HPV vaccine. Regular cervical cancer screenings and the HPV vaccine can prevent the development of cervical cancer that cause bleeding after sex. HPV and abnormal pap smears are common, and not all patients with abnormal pap smears will have bleeding.
Get tested for STIs and practice safe sex. Using barrier-method protection, like condoms, and getting tested for STIs each time you have a new partner can significantly reduce the likelihood of getting an infection that can cause irregular bleeding.
Switch your birth control method. If your birth control is causing frequent or prolonged bleeding after sex, it may be time to switch. Talk to your doctor about the symptoms you are experiencing and they can help you choose a contraceptive method that is right for you.
Maintain open communication with your partner during sex. Sex should always be consensual, and it should also always be enjoyable. If you are experiencing any type of pain or discomfort during sex, you should communicate with your partner.
If you are experiencing bleeding after sex, it’s always best to call your doctor. Even though post-sex vaginal bleeding is common and not always a cause of concern, it could be a sign of an STI, yeast infection, or even cervical cancer.
“Anytime that patient has bleeding after intercourse unless it’s associated with your period, it’s always a good idea to call your provider just to make sure that something’s not abnormal,” says Geida. If you are experiencing heavy bleeding with clots, seek medical attention immediately.
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