Post-Sexual Bleeding: Causes and Concerns for Women

Bleeding during sexual intercourse?

Hello, I had sexual intercourse on November 4th, and afterward, I noticed brown discharge on the condom.
Shortly after, I went to the bathroom and noticed light bleeding, which continued the next day with a flow similar to menstruation.
I visited a doctor, and during the pelvic exam, the doctor mentioned that the amount of bleeding did not seem typical for post-coital bleeding (due to the volume being significant).
An ultrasound was performed, and everything appeared normal, but I feel it might not be my menstrual period (as the doctor later advised me to take a pregnancy test).
The doctor then suggested to consider it as my menstrual period.
Currently, on the fourth day, the bleeding has decreased, but I am still a bit concerned.
My menstrual cycle is irregular; the last period started on September 12th.
I also had a Pap smear in July, which indicated inflammation.
Could the bleeding possibly be caused by inflammation? Is there a chance it could be erosion that was not diagnosed?

L, 20~29 year old female. Ask Date: 2018/11/07

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On November 4th, I had sexual intercourse and afterward noticed brown discharge on the condom.
Shortly after, I went to the bathroom and noticed a light bleeding that continued into the next day, resembling menstrual flow.
I visited a doctor, and during the pelvic examination, the doctor mentioned that the amount of bleeding did not seem typical for post-coital bleeding (due to the volume being significant).
An ultrasound was performed, and everything appeared normal.
However, I feel that this should not be my menstrual period (as the doctor advised me to take a pregnancy test after the ultrasound).
The doctor later suggested to consider it as my menstrual period.
Currently, on the fourth day, the bleeding has decreased, but I am still somewhat concerned.
My menstrual cycles are irregular; the last one started on September 12th.
I also had a Pap smear in July of this year, which indicated inflammation.
Could the bleeding possibly be caused by inflammation? Also, is it possible that there is erosion that hasn't been diagnosed? Erosion would typically be identified during a pelvic examination by a doctor.

Reply Date: 2018/11/07

More Info

Post-sexual bleeding can be a concerning symptom for many women, and understanding its potential causes is crucial for addressing any underlying health issues. Based on your description, it seems you experienced some unusual bleeding after sexual intercourse, which has raised questions about its origin and significance.

Firstly, it’s important to note that post-coital bleeding can arise from various sources. Common causes include:
1. Cervical or Vaginal Trauma: During sexual intercourse, especially if there is insufficient lubrication or if the activity is vigorous, minor trauma to the vaginal or cervical tissues can occur, leading to bleeding. This is often characterized by light spotting or a small amount of blood.

2. Infections: Conditions such as cervicitis (inflammation of the cervix) or vaginitis (inflammation of the vagina) can lead to abnormal bleeding. These infections can be caused by sexually transmitted infections (STIs) or other pathogens, and they may also present with additional symptoms such as unusual discharge, itching, or discomfort.

3. Hormonal Imbalances: Irregular menstrual cycles, as you mentioned, can be influenced by hormonal fluctuations. Conditions like polycystic ovary syndrome (PCOS) or thyroid dysfunction can lead to unpredictable bleeding patterns.

4. Cervical Polyps or Fibroids: These benign growths can cause bleeding, especially after sexual activity. They are often asymptomatic but can be detected during a pelvic examination.

5. Endometrial Issues: Conditions affecting the endometrium, such as endometriosis or endometrial hyperplasia, can also lead to abnormal bleeding. These conditions may not always present with obvious symptoms, making them harder to diagnose without appropriate imaging or biopsy.

In your case, since the bleeding was significant enough to resemble a menstrual flow and was accompanied by a history of irregular cycles, it is essential to consider these factors. The fact that your doctor performed an ultrasound and found no abnormalities is reassuring, but it does not entirely rule out the possibility of underlying issues like inflammation or even cervical erosion (ectropion), which may not always be visible on imaging.

Regarding your concern about inflammation causing the bleeding, it is indeed possible. Inflammation of the cervix or vagina can lead to increased vascularity and sensitivity, making these tissues more prone to bleeding, especially after sexual activity. If you had a previous Pap smear that indicated inflammation, it might be worthwhile to follow up on this with your healthcare provider.

As for the possibility of cervical erosion or other lesions, if you continue to experience abnormal bleeding or if the bleeding does not resolve, it would be prudent to seek further evaluation. A thorough examination, possibly including a repeat Pap smear or a colposcopy, may be warranted to rule out any significant pathology.

In conclusion, while some post-sexual bleeding can be benign and self-limiting, it is essential to monitor the situation closely. If the bleeding persists, worsens, or is accompanied by other symptoms such as pain, fever, or unusual discharge, seeking further medical evaluation is crucial. Your health and peace of mind are paramount, and addressing any concerns with a healthcare provider will help ensure that any potential issues are identified and managed appropriately.

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