Post-Sexual Bleeding: Causes and Next Steps

Postcoital bleeding

Hello Doctor, the last time I had unprotected intercourse with my boyfriend was on March 6, and we used condoms on March 14.
My last menstrual period started on February 10, and I haven't gotten my period this month yet.
Therefore, I took a pregnancy test with my first morning urine on March 17, which showed one line.
Does this mean that the possibility of pregnancy can be ruled out? That evening, I had unprotected intercourse again, and there was a little bit of blood afterward; I'm not sure if this means my period is coming.
Should I take another test in a week for accuracy, or should I go see a doctor directly?
I previously took emergency contraceptive pills for about four years and stopped gradually last year.
On December 13, I had unusual discharge and hadn't had my period for two months.
I went to see a doctor, who said I was already two months pregnant, and I decided to terminate it.
Later, I told the doctor I wanted to start taking emergency contraception again, and the doctor said I could start a week later.
I took it for two months; my first period was very light, and the second one (on February 10) was a bit heavier but still not normal.
I decided to stop taking the pills because my menstrual cycle has always been very irregular, and I relied heavily on the emergency contraceptive pills.
However, after long-term use, I feel my body hasn't been very well.
What should I do next? Thank you, Doctor.

Xinxin, 20~29 year old female. Ask Date: 2020/03/18

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
For pregnancy concerns, please perform a home pregnancy test or consult a gynecologist for evaluation four weeks after sexual intercourse.
2.
There are too many factors related to abnormal menstrual cycles; it is recommended to see a gynecologist for assessment.

Reply Date: 2020/03/18

More Info

Post-sexual bleeding can be a concerning symptom for many individuals, and understanding its potential causes is crucial for determining the appropriate next steps. Based on your description, there are several factors to consider regarding your recent experiences with bleeding after sexual activity, as well as your menstrual cycle and contraceptive history.

Firstly, it’s important to note that bleeding after sexual intercourse can occur for various reasons. Some common causes include:
1. Cervical or Vaginal Trauma: If sexual activity is vigorous or if there is insufficient lubrication, it can lead to minor injuries in the vaginal or cervical tissues, resulting in bleeding. This seems to be a possibility in your case, especially if you experienced some discomfort during intercourse.

2. Hormonal Fluctuations: Since you have a history of irregular menstrual cycles, hormonal imbalances could be contributing to your symptoms. Hormones regulate the menstrual cycle, and any fluctuations can lead to unexpected bleeding or changes in menstrual flow.

3. Implantation Bleeding: If there is a possibility of pregnancy, light bleeding can sometimes occur when a fertilized egg implants itself into the uterine lining. However, given that you tested negative for pregnancy on March 17, this may be less likely unless the test was taken too early.

4. Infections: Sexually transmitted infections (STIs) or other vaginal infections can cause bleeding after intercourse. If you have any additional symptoms such as unusual discharge, itching, or odor, it would be wise to get tested.

5. Other Medical Conditions: Conditions such as polyps, fibroids, or endometriosis can also lead to abnormal bleeding. If the bleeding persists or is accompanied by pain, it is essential to consult a healthcare provider.

Regarding your menstrual cycle, you mentioned that your last period was on February 10, and you have not yet had a period this month. Given your history of irregular cycles and the recent changes after stopping the contraceptive pill, it is not uncommon for your body to take some time to readjust. The fact that you experienced bleeding after intercourse could indicate that your period is approaching, but it is not definitive.

As for the pregnancy test, a single line typically indicates that you are not pregnant. However, if you had unprotected intercourse after the test, there is still a possibility of pregnancy, especially if you are experiencing irregular cycles. It is advisable to wait a week and retest if your period does not arrive. If you continue to experience unusual bleeding or if your symptoms worsen, seeking medical advice is crucial.

In summary, while occasional post-sexual bleeding can be normal, especially after vigorous activity, it is essential to monitor your symptoms closely. If the bleeding persists, becomes heavier, or is accompanied by pain or other concerning symptoms, please consult a healthcare provider for a thorough evaluation. They may recommend a pelvic examination, ultrasound, or other tests to rule out any underlying conditions. Additionally, if you are considering resuming hormonal contraception or exploring other birth control options, discussing this with your healthcare provider can help you find the best method for your health and lifestyle.

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