Postpartum Bleeding During Intercourse: Causes and Concerns Explained

Postpartum sexual intercourse bleeding?

Hello doctor, I would like to ask about something.
It has been 6 months since I gave birth, and I am exclusively breastfeeding.
When my child presses on my lower abdomen, I feel slight pain.
Whenever I have sexual intercourse with my husband, even if it is just a little vigorous, I experience bleeding.
Before giving birth, I never had bleeding during intercourse.
During my postpartum check-up one month after delivery, the doctor said I was healing well and could resume sexual activity.
The cervical smear report indicated mild inflammation.
Given that several months have passed, I would expect it to have healed naturally.
Could you please explain why I am experiencing bleeding? Is the inflammation mentioned in the report related to this?

Xiao Xiang, 20~29 year old female. Ask Date: 2018/10/19

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the factors that can affect the menstrual cycle or cause intermenstrual bleeding are numerous, including age, environment, lifestyle, stress, emotional instability, weight changes, medications, emergency contraceptive pills, diet, polycystic ovary syndrome, uterine or cervical lesions, infections, ovulation, pregnancy, and breastfeeding, among others.
It is recommended that if symptoms persist or worsen, you should consult a gynecologist to check for hormonal imbalances or other underlying causes.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2018/10/19

More Info

Postpartum bleeding during intercourse can be concerning, especially when it occurs several months after childbirth. It's important to understand the potential causes and implications of this symptom.
Firstly, postpartum bleeding can occur for various reasons, and it is essential to differentiate between normal healing processes and potential complications. After childbirth, the body undergoes significant changes, including hormonal fluctuations and physical healing of the reproductive organs. In your case, since you mentioned that you are six months postpartum and exclusively breastfeeding, it is crucial to consider the following factors:
1. Hormonal Changes: Breastfeeding can lead to lower estrogen levels, which may affect the vaginal tissues. Low estrogen can cause vaginal dryness and thinning of the vaginal walls, making them more susceptible to irritation and bleeding during intercourse. This could explain the bleeding you experience during more vigorous sexual activity.

2. Cervical Inflammation: You mentioned that your Pap smear indicated mild inflammation. This inflammation could be due to various factors, including hormonal changes, infections, or irritation. If the cervix is inflamed, it may bleed more easily during intercourse, especially if there is any friction or pressure applied.

3. Infection: Although you had a postpartum check-up that indicated healing, it is still possible to develop an infection in the postpartum period. Conditions such as cervicitis (inflammation of the cervix) or vaginitis (inflammation of the vagina) can lead to abnormal bleeding. If you experience any unusual discharge, odor, or discomfort, it would be wise to consult your healthcare provider for further evaluation.

4. Physical Trauma: The physical changes that occur during childbirth can lead to scarring or changes in the vaginal and cervical tissues. If there was any tearing or trauma during delivery that has not healed properly, this could also lead to bleeding during intercourse.

5. Other Considerations: Other potential causes of bleeding could include polyps, fibroids, or other structural abnormalities in the uterus or cervix. While these are less common, they should be considered if bleeding persists.

Given your situation, it is advisable to follow up with your healthcare provider. They may recommend a pelvic examination to assess for any signs of infection, inflammation, or structural issues. Additionally, they may suggest a vaginal ultrasound or other imaging studies to ensure that everything is healing properly.

In the meantime, consider using a water-based lubricant during intercourse to help alleviate any discomfort due to dryness. This may reduce the likelihood of bleeding caused by friction.
In summary, while postpartum bleeding during intercourse can be concerning, it is often manageable with appropriate medical evaluation and treatment. It is essential to communicate openly with your healthcare provider about your symptoms and any concerns you may have, as they can provide personalized advice and care based on your specific situation. Remember that your health and comfort are paramount, and seeking help is a crucial step in addressing these issues.

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