Post-Sexual Bleeding: Causes and Solutions for Women

Postcoital bleeding

Hello, doctor! I would like to ask you a question! I have been taking oral contraceptives for six months, and I have not had any issues with sexual intercourse until last month when I started experiencing bleeding for several days.
The blood was brownish, and the last time I stopped bleeding was just when my period started.
After my period ended, I did not have any more bleeding, but a few days ago, after having intercourse again, I started bleeding once more.
Could this be related to deep penetration? Because every time after intercourse, if I tighten my abdomen, I feel a bit of soreness.
Currently, I am abroad and have had a vaginal ultrasound, and the doctor said there were no issues.
Is there any way to improve this situation?

Mary, 20~29 year old female. Ask Date: 2020/01/14

Dr. Huang Yuande reply Obstetrics and Gynecology

Thank you for your question.
Based on the clinical information provided, it is difficult to make a definitive assessment.
If there is bleeding after sexual intercourse, it could be related to cervical issues, such as polyps or tumors, or it may be blood coming from the endometrium.
Therefore, a clinical examination is necessary for proper evaluation.
It is advisable to start with a Pap smear for further investigation.

Reply Date: 2020/01/14

More Info

Post-sexual bleeding can be a concerning issue for many women, and understanding its potential causes is essential for addressing any underlying health concerns. Based on your description, it seems that you have been experiencing intermittent bleeding after sexual intercourse, particularly after engaging in sexual activity. This bleeding has been characterized by a dark, coffee-colored discharge, which can sometimes be alarming.

There are several potential causes for post-sexual bleeding, and it is important to consider each one:
1. Trauma or Injury: One of the most common reasons for bleeding after intercourse is trauma to the vaginal walls or the cervix. This can occur if there is vigorous sexual activity or if penetration is deep. If the vaginal tissues are sensitive or if there is insufficient lubrication, this can lead to micro-tears, resulting in bleeding.
2. Cervical Issues: Conditions affecting the cervix, such as cervical inflammation (cervicitis), cervical polyps, or even cervical dysplasia, can cause bleeding after sexual activity. These conditions may not always present with pain or discomfort, making them harder to identify without a thorough examination.

3. Hormonal Fluctuations: Since you mentioned that you have been on hormonal birth control for six months, it is important to note that hormonal contraceptives can sometimes lead to breakthrough bleeding, especially during the first few months of use. This is due to the hormonal changes affecting the uterine lining. If you have recently started or changed your birth control method, this could be a contributing factor.

4. Endometrial Changes: The endometrium, or the lining of the uterus, can also be affected by hormonal changes. If there is any irregular shedding of the endometrial lining, it can lead to spotting or bleeding between periods. This is sometimes referred to as "spotting" and can be common in women who are on hormonal contraceptives.

5. Infections: Sexually transmitted infections (STIs) or other vaginal infections can cause inflammation and bleeding. If there are any accompanying symptoms such as unusual discharge, itching, or odor, it would be wise to get tested for STIs.

6. Other Medical Conditions: Conditions such as endometriosis or fibroids can also lead to abnormal bleeding. While these conditions may not always present with obvious symptoms, they can cause changes in bleeding patterns.

Given that you have already undergone a vaginal ultrasound and your doctor did not find any significant issues, it is a positive sign. However, if the bleeding persists or worsens, it is crucial to follow up with your healthcare provider. They may recommend further testing, such as a Pap smear or additional imaging, to rule out any underlying conditions that may not have been detected initially.

To manage and potentially improve this situation, consider the following steps:
- Communication with Your Partner: Discuss any discomfort or pain during intercourse with your partner. Adjusting positions or ensuring adequate lubrication may help reduce trauma during sexual activity.

- Regular Check-ups: Continue to have regular gynecological exams to monitor your reproductive health. If you notice any changes in your menstrual cycle or experience new symptoms, report these to your healthcare provider.

- Consider Hormonal Adjustments: If breakthrough bleeding continues to be an issue, discuss with your doctor the possibility of adjusting your birth control method or exploring other contraceptive options that may be better suited for your body.

- Monitor Symptoms: Keep a record of when the bleeding occurs, its duration, and any other symptoms you experience. This information can be helpful for your healthcare provider in diagnosing the issue.

In conclusion, while post-sexual bleeding can be concerning, understanding the potential causes and working closely with your healthcare provider can help identify and address any underlying issues. Always prioritize your health and seek medical advice if you have any concerns.

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